435 


UC-NRLF 


B    3    fiT7    OMfi 


liillii 


♦'^-^ 


THE  LIBRARY 

OF 

THE  UNIVERSITY 

OF  CALIFORNIA 


PRESENTED  BY 

PROF.  CHARLES  A.  KOFOID  AND 

MRS.  PRUDENCE  W.  KOFOID 


9      £' 

4    w 


HISTORY 

DESCRIPTION   AND   STATISTICS 


? 


OF 


THE  BLOOMINGDALE   ASYLUM 


FOR 


THE    INSANE. 


BY    PLINY    EARLE,    M.    D. 

PHYSICIAN    TO  THE  INSTITUTION  : 

ilSMBEE    OF    THE    ITATIONAL    MEDICfL    ASSOCIATION,    FELLQ-W    OF     THE    COLLEGE 

OP    PHYSICIANS    AND    SUBGEONS    OP     NEW-YOKE:,    FELLOW     OP    THB     N3W- 

YQHK     ACADEMY     OF     MEDICINE,     AND     CORRESPONDING    MEMBER 

OF     THE    MEDICAL     SOCIETY    OP  ATHENS,    OREECE. 


N  E  W  -  Y  O  R  K  : 
EGBERT,  HOVEY  &  KING,  PRINTERS,  .374  PEARL-STKEET. 

1848. 


PRESIDENTS  AND  VICE  PRESIDENTS 

Of  the  New-York  Hospital,  and  ex-officio  Monthly  Inspectors  of 
the  Bloomingdale  Asylum  for  the  Insane. 

PRESIDENTS. 

Matthew  Clarkson,     -  1821 

Thomas    Eddy,     -  from  1822  to  1827 

Peter  Augustus  Jay,  "       1827    "    1833 

George  Newbold,  -       1833.    Continues  in  office. 

VICE-PRESIDENTS. 

Thomas  Eddy,  -  1821 

Peter  Augustus  Jay,      from  1822  to  1827 

Thomas  Buckley,  "       1827    "    1833 

Najah  Taylor,  "       1833    "    1837 

Isaac   Carow,  "      i837.  Continues  in  office. 


GOVERNORS  OF  THE  NEW- YORK  HOSPITAL 

Who  were  members  of  the  Bloomingdale  Asylum   Committee,  and  the  years 

during  which  they  respectively  filled  that  office,  from 

1821  to  1847,  inclusive. 

0 

N.  B. — The  years  in  which  each  Governor  was  upon  the  Committee,  are  placed  opposite  his  name. 
The  official  year  of  the  Committee  commences  in  June. 

Thomas  Eddt,        1821,  1824,  1825. 

Cadwallader  D,  Golden,  1821,  1823. 

Thomas  Buckley,      1821,  1822,  1823,  1824,  1825,  1826,  1827,  1828. 

John  Adams,  1821,  1823,  1824,  1825. 

John  B.  Laweence,     1821,  1822,  1823,  1824,  1825,  lS26,  1827,  182&, 

1830, 1831. 
Thomas  C.  Taylor,     1821,  1822, 
William  Bayard,      1822. 
John  McComb,        1822,  1823. 
John  Clark,        '  1822,  1824,  1825,  1826. 
Najah  Taylor,       1823,  1824,  182.5,  1826,  1828,  1829, 1830,  1832, 

1833,  1834,  1836,  1837,  1838. 
GuLiAN  C.  Verplanck,  1826,  1827,  1833,  1834,  1835. 
James  Lovett,        1826, 1827, 1828,  1834,  1835,  1836,  1844, 1845, 

1846. 
Benjamin  L.  Swan,     1827,  1828,  1829,  1831, 1832, 1833, 1838, 1839, 

1840,  1842,  1843,  1844. 
Philip  Hone,         1827,  1828,  1820. 
Nathaniel  Richards,   1828,  1829,  1830,  1832,  1833, 1834, 1837, 1038, 

1839,  1841,  1842,  1843. 
James  Heard,        1829,  1830,  1831,  1833,  1834. 
Thomas  R.  Smith,     1830,  1831,  1832,  1835,  1836,  1837. 
John  A.  Stevens,      1830,  1831,  1832. 
Henry  I.  Wyckoff,    1831,  1832,  1833,  1835,  1836. 
Peter  G.  Stuyvesant,  1834,  1835. 

Robert  C.  Cornell,    1835,  1836,  1837,  1839,  1840,  1841. 
Stephen  Allen,       1836,  1837,  1838,  1840,  1841,  1842,  1845,1846, 

1847. 
Samuel  P.  Mott,      1837,  1838,  1839,  1842,  1843,  1844. 
Richard  M.  Lawrence,  1838,  1339,  1840,  1843,  1844,  1845,  1847. 
Augustus  Fleming,     1839,  1840,  1841,  1843,  1844,  1845. 
James  I.  Jones,        1840,  1841,  1842,  1844, 1845, 1846. 
Wm.  M.  Halsted,     1841,  1842,  1843,  1845,  1846,  1847. 
David  S.  Kennedy,     1846,  1847. 
James  Donaldson,      1846,  1847. 
Stacy  B.  Collins,     1847. 


TABLE  OF  CONTENTS. 


PART  FIRST. 

Section  i.— Origin  and  Peogress  of  the  Bloomingdale  AsyluiM,  7 

"       n. — On  the  Reception  of  Patients,        .        .        .        .  14 
Table  i.  Monthly  Admissions  from  June  16,  1821,  to 

December  31,  1844, 15 

Table  ii.  Monthly  Discharges,        ....  16 
Table  iii.  Daily  average  number  of  Patients  for  each  month,  17 

Table  iv.     "        "           "           «               "        year,  19 

PART    SECOND. 

PRESENT  STATE  OF  THE  ASYLUM. 

Sectios  I,— Of  the  Farm  and  Buildings,           ....  22 

"      n. — Moral  Treatment, 26 

i.  Manual  Labor, 26 

ii.  Religious  Worship, 28 

iii.  Recreative  Exercise, 

a.  Importance  of  Exercise, 29 

b.  Airing  Courts  or  Yards,          ....  29 

c.  Walking, 31 

d.  Riding, ,        .  31 

iv.  Instruction. 

a.  Lectures, 31 

b.  School, 33 

c.  Library,             34 

v.  Amusements, 

a.  Grames, 34 

b.  Music, .  84 

c.  Parties, 35 

d.  Dancing,  ,36 

vi.  Restraints,           .     • 35 

vii.  Attendants,            37 


TABLE    OF   CONTENTS. 


PART    THIRD. 

AN  ANALYSIS  OF  THE  CASES  ADMITTED  INTO  THE  ASYLUJI  PREVIOUSLY  TO  DEC.  31,  1844. 

CHAPTER  I. 


cases   of    delirium  tremens. 

Section  i. — Of  the  Number  of  Patients  Admitted, 
"     II. — Of  First  Admissions,       .        .        ;        . 

Nativity  and  Residence,  .         .        .         . 

Profession  or  Occupation,        .... 

Age, 

Civil  Condition, 

Results, 

Section  hi. — Of  Re-admissions. 

1st.    Of  Second  Admissions, 

2d.      Of  Third  Admissions, 

3d.      Of  Fourth  Admissions,      .        .•        .         , 

4th.     Of  Fifth  Admissions,     .... 

6th.     Of  Sixth  Admissions,         .        .         .        . 

6th.    Of  Seventh  Admissions, 

7th.    Of  Admissions  subsequent  to  the  seventh, 

CHAPTER  II. 

cases   of    insanity. 

Section  i.— Of  the  Number  of  Patients  Admitted, 
"    n. — Of  First  Admissions  in  Reference  to  Time, 

"  m.— Sex, 

"  rv. — Nativity  and  Residence,        .... 

"    V. — Age,  

"  vi. — Civil  Condition, 

"  vn. — Occupation, 

"  vm. — Causes  of  Insanity, 

Hereditary  Predisposition, 

Physical  Causes,      ...  .        . 

Moral  Causes, 

Section  dc.  Form  of  Disease, 

"      X.  Previous  Attacks  of  Insanity, 
"     XI.  Of  the  Suicidal  Propensity, 
"    xn.  Of  the  Homicidal  Propensity, 


Page. 
39 
40 
41 
42 
44 
44 
45 

46 
46 
47 
47 
47 
48 
48 


52 

55 

59 

63 

65 

69 

71 

76 

77 

84 

85 

101 

103 

104 

107 


TABLE  OF  CONTENTS. 


5 


Page. 

Section  xiu.  Condition  of  the  Patients  when  discharged  from  the 

Asylum, 1^^ 

"      XIV.  Time  of  Residence  in  the  Astlum  of  the  Patients 

WHO  were  Cured, 112 

"      XV.  Curability  as  connected  with  Age,   .        .  114 

"     XVI.  Elopements, H' 

"     xvn.  Time  of  Residence  in  the  Asylum,     .        .        .  118 

"   xvni.  Of  Re-admissions, 

1st.  Second  Admissions,  .         .        .       ' .         •       120 

2d.   Tliird  Admissions, 120 

3d.  Fourth  Admissions, 121 

4th.  Fifth  Admissions, 121 

5th.  Sixth  Admissions, 121 

6th.  Seventh  Admissions, 121 

7th.  Eighth  Admissions, 122 

8th.  Ninth  Admissions, 122 

9th.  Tenth  Admissions, 122 

10th.  Eleventh  Admissions,  .        .        •        •  122 

11th.  Admissions  subsequent  to  the  Eleventh,  .       123 

12th.  Aggregate  Results  of  Re-admissions,   .        .  123 

Section  xix.  Of  Re-admissions  in  reference  to  the  Condition  at 

time  of  Discharge  on  First  Admission,        .  124 

Section    xx.  Time  of  Residence  in  the  Asylum  of  the  Patients 

Re-admitted, l^"^ 

Section  xxi.  Mortality, 1^ 

>'     xxn.  Mortality  in  its  Relation  to  Months  and  Seasons,    ^  132 
"    xxHi.  Time  of  Residence  in  the  Asylum  of  Patients  avho 

Died, 133 

"    xxiv.  Mortality  in  Relation  to  Age,       .        .        .  135 

"    XXV.  Diseases  Resulting  in  Death,        ....      136 


PART   FIRST. 


SECTION  I. 

ORIGIN  AND  PROGRESS  OF  THE  BLOOMINGDALE  ASYLUM. 

The  origin  of  the  Institution  now  known  as  the  Blooming- 
dale  Asylum  for  the  Insane,  may  be  considered  as  going 
back  to  that  of  the  New- York  Hospital,  of  which  it  is  still  a 
branch,  and  under  the  direction  of  the  same  Board  of 
Governors,  The  first  movement  towards  the  foundation 
of  the  Hospital,  is  thus  mentioned  in  an  address  delivered 
by  Dr.  Peter  Middleton,  in  Columbia  (then  King's)  College, 
in  the  city  of  New- York,  on  the  3d  of  November,  1769. 

"  The  necessity  and  usefulness,"  says  he,  "  of  a  public 
Infirmary,  has  been  so  warmly  and  pathetically  set  forth  in 
a  disoourse  delivered  by  Dr.  Samuel  Bard,  at  the  college 
commencement,  in  May  last,  that  his  Excellency,  Sir  Henry 
Moore,  immediately  set  on  foot  a  subscription  for  that  pur- 
pose, to  which  himself  and  most  of  the  gentlemen  present 
liberally  contributed." 

Subscriptions  to  this  fund  were  continued,  and  in  1770, 
Doctors  Peter  Middleton,  John  Jones  and  Samuel  Bard,  pre- 
sented to  the  Colonial  Government,  a  petition  for  the  incor- 
poration of  a  public  Hospital,  which  was  granted  by  a 
charter  bearing  the  date  of  June  13th,  1771,  incorporating 
the  "  Society  of  the  Hospital,  in  the  city  of  New- York,  in 
America."*  The  management  of  the  Institution  was  vested 
in  a  Board  of  twenty-six  Governors.  The  philanthropic 
enterprise  was  also  aided  by  the  celebrated  Dr.  John  Fother- 
gill,  and  Sir  William  Duncan,  of  England,  through  whom  the 

*  In  1810,  this  title  was  changed  to  "  The  Society  of  the  New  York  Hospital." 


8 
fuuds  of  the  Society  were  considerably  increased,  by  dona- 
tions from  persons  in  different  parts  of  Great  Britain. 

A  building  was  commenced  in  1773,  and  having  pro- 
gressed almost  to  completion,  was  nearly  consumed  by  fire,  on 
the  28th  of  February,  1775.  Through  pecuniary  aid  from  the 
Colonial  Legislature,  the  Governors  were  enabled  to  recon- 
struct the  edifice ;  but  the  revolutionary  war,  as  well  as  some 
other  causes,  prevented  it  from  being  ready  for  the  reception 
of  patients  until  the  3d  of  January,  1791.  It  was  then 
opened  as  a  Hospital  for  general  diseases. 

In  the  month  of  May,  1797,  two  cases  of  mania  were 
admitted.  This  is  the  first  notice  which  we  have  been  able 
to  discover  of  the  treatment  of  Insanity  in  this  Institution, 
but  as  the  record  states  that,  in  the  same  month,  two  cases 
were  cured  and  one  died,  it  is  evident  that  at  least  one  had 
been  previously  admitted.  In  the  following  month,  June, 
seven  cases  of  mania  were  received,  two  cured  and  two 
relieved. 

The  following  statistics  of  insane  patients  are  taken  from 
the  records  of  the  Institution,  for  1798. 


April, 

May, 

June, 

July, 

August, 

September, 

October, 

November, 

December, 

The  whole  number  of  Insane  received  previously  to  the 
31st  December,  1803,  was  215.  This  class  of  patients  ap- 
pears now  to  have  been  rapidly  increasing.  The  apartments 
devoted  to  them  were  neither  sufficiently  extensive,  nor  well 
adapted  to  their  proper  accommodation.  Influenced  by  these 
considerations,  as  well  as  by  the  multiform  annoyances  and 


Remaining  from 
last  moDth. 

Received  this 
montli. 

7 

0 

7 

4 

9 

3 

9 

1 

8 

1 

9 

1 

7 

0 

5 

0 

5 

2 

9 


disadvantages  to  both  classes  of  patients,  necessarily  atten- 
dant upon  placing  lunatics  and  patients  with  general  dis- 
eases in  the  same  building,  the  Board  of  Governors  resolved 
to  erect  a  separate  building  to  be  exclusively  devoted  to  per- 
sons laboring  under  mental  disorder. 

Having  received  assistance  from  the  Legislature  of  the 
State,  they  erected  a  substantial  and  spacious  stone  edifice, 
on  the  grounds  of  the  Hospital  in  the  city,  within  the  same 
enclosure,  and  but  a  few  rods  distant  from  the  original 
building.  It  was  finished  and  opened  on  the  1 5th  of  July,  1 808. 
On  that  day,  nineteen  patients  were  removed  to  it  from 
the  wards  of  the  other  building,  and  forty-eight  were  ad- 
mitted. This  new  department  was  called  the  "  Lunatic 
Asyliun,"  and  Dr.  Archibald  Bruce  received  the  appointment 
as  its  Physician.  In  1817,  he  was  succeeded  by  Dr.  William 
Handy,  upon  whose  resignation,  in  1819,  Dr.  John  Neilson 
was  appointed,  and  fulfilled  the  duties  of  the  office  imtil 
July,  1821,  when  the  building  ceased  to  be  used  for  the 
Insane. 

The  following  table  exhibits  the  number  of  insane  pa- 
tients admitted  previously  to  the  27th  of  July,  1821,  together 
with  the  results  of  their  treatment. 


eviously  to  the  year 

1811 

643 

the  year  1811 

108 

1812 

127 

«    "    1813 

105 

1814 

104 

1815 

69 

1816 

49 

1817 

49 

1818 

75 

1819 

77 

1820 

87 

1821 

60 

1553^ 

Itisprobable  that  many  of  tbese  were  cases  of  Delirium  Tremens. 
1 


10 


Of  whom  were  cured, 
Relieved,     . 
Discharged  by  request, 
Were  improper  objects. 
Disorderly  or  eloped,  ^^ 
Died,  .... 


704 

239 

278 

61 

65 

154 

lie  Asylum, 

52 

1553 


The  experience  gained  during  the  progress  of  this  Asylum* 
enabled  the  Governors  of  the  Hospital  to  obtain  more  dis- 
tinct views  of  the  nature  of  Insanity,  as  well  as  of  the 
means  essential  to  its  judicious  treatment.  At  the  same 
time,  they  received  intelligence  of  the  favorable  progress  in 
the  enterprise  for  nieliorating  the  condition  of  the  Insane,  in 
Europe,  and  particularly  as  exhibited  in  the  operations  of 
the  Retreat,  near  York,  in  England.  Thus  stimulated  to 
renewed  benevolent  exertion,  the  Governors,  in  1815,  having 
received  a  communication  upon  the  subject  from  the  late 
Thomas  Eddy,  whose  exertions  in  the  cause  were  constant 
and  untiring,  determined  to  purchase  a  farm  in  the  vicinity 
of  the  city,  and  cause  to  be  erected  thereon,  an  edifice 
adapted  to  the  wants  of  persons  suffering  from  mental 
alienation. 

The  pecuniary  means  of  the  Society  were,  however,  in- 
sufficient to  enable  them  to  undertake  this  enterprise  upon 
a  scale  commensurate  with  their  enlarged  and  accurate 
views  of  the  necessities  of  the  persons  towards  the  restora- 
tion, or  the  comfortable  accommodation  of  whom,  their  sym- 
pathies and  energies  were  directed.  In  this  emergency,  they 
applied  to  the  Legislature  of  the  State,  which,  with  a  gene- 
rosity worthy  of  perpetual  commemoration,  seconded  their 
views,  and,  on  the  17th  of  April.  1 81 G,  granted  to  the  Society 
an  annuity  of  $10,000  until  the  year  1857. 

A  tract  of  thirty-nine  acres  of  land,  upon  a  portion  of 


11 

which  the  Leake  and  Watts  Orphan  House  has  since  been 
erected,  was  purchased,  with  the  intention  of  constructing 
the  Asylum  building  thereupon.  Subsequently,  a  tract  of 
twenty  acres,  near  Yorkville  and  on  the  borders  of  the  East 
River,  being  by  some  considered  as  more  appropriate  for  the 
Institution,  from  the  fact  of  its  lying  less  remote  from  the 
city,  was  also  bought,  but,  upon  further  consideration,  was 
sold.  At  length,  a  farm  of  about  twenty-six  acres,  adjoin- 
ing the  original  purchase,  and  bounded,  on  the  opposite  side, 
by  the  Bloomingdale  road,  was  fortunately  obtained.  This 
is  the  most  favorable  site  for  an  Institution  of  the  kind  upon 
the  Island  of  JManhattan. 

The  corner  stone  for  the  principal  edifice  was  laid  on  the 
7th  day  of  May,  1818.  This  building  was  completed  about 
the  close  of  the  year  1820,  and,  under  the  name  of  Blooming- 
dale  Asylum,  was  opened  for  patients,  in  June,  1821. 

The  management  of  the  Institution  was  vested  in  a  Com- 
mittee of  six,  appointed  by  the  Board  of  Governors  from 
among  its  own  numbers.  The  action  of  this  Committee  is 
subordinate  to  the  Board,  before  which  the  minutes  of  their 
proceedings  are  read  at  each  Monthly  Meeting. 

The  Institution  was  organized  by  the  election  of  Laban 
Gardner  as  vSuperintendent,  his  wife  as  Matron,  and  Dr. 
James  Eddy  as  resident  Physician.  The  executive  direction 
and  control  of  the  establishment,  in  all  its  departments,  ex- 
cepting the  medical  treatment  of  the  patients,  was  delegated 
to  the  Superintendent. 

The  general  direction  of  the  medical  treatment  was  placed 
in  the  hands  of  an  Attending  Physician,  who  was  required  to 
visit  the  patients  twice  a  week.  Dr.  John  Neilson,  who, 
during  the  two  previous  years,  had  acted  as  Physician  to  the 
Lunatic  Asylum  in  the  City,  received  the  appointment  to  this 
office,  the  duties  of  which  he  fulfilled  until  January,  1831, 
when  he  resigned. 


12 

The  Resilient  Physicians,  subsequent  to  Dr.  Eddy,  were  as 
follows : — 

Albert  Smith,  M.  D.  from  September,  1822,  to  March,  1824. 
John  Neilson,  jun.  M.  D.  from  March,  1824,  to  May,  1824. 
Abraham  Y.  Williams,  M.  D.  from  May.  1824,  to  June,  1825. 
James  Macdonald,  M.  D.  from  June,  1825,  to  December,  1830. 
Guy  C.  Bayley,  M.  D.  from  December,  1830,  until  the  time 
of  the  reorganization  of  the  Institution. 

As  the  number  of  patients  increased,  the  apartments  for 
their  accommodation  became  too  limited,  and  the  facilities 
for  their  suitable  classification  insufficient.  Consequently, 
in  1829,  the  men's  department  was  enlarged  by  the  erection 
of  another  building,  containing  rooms  for  thirty  patients; 
and,  in  1837,  a  corresponding  edifice  was  constructed  for  the 
females. 

The  Board  of  Governors,  believing  that  a  change  in  the 
organization  would  contribute  to  the  usefulness  of  the  Insti- 
tution, at  length  determined  to  dispense  with  the  Attending 
Physician,  make  the  Resident  Physician  the  principal  officer, 
and  invest  him  with  the  entire  immediate  control  of  the  moral, 
as  well  as  the  medical  treatment  of  the  patients.  Accord- 
ingl}-,  in  the  early  part  of  May,  1831,  Dr.  James  Macdonald 
received  the  appointment  of  Physician,  and  was  delegated  to 
visit  some  of  the  principal  institutions  for  the  Insane  in  Eu- 
rope, in  order  to  become  more  fully  acquainted  with  their 
manngement  and  recent  improvements.  After  an  absence 
of  fifteen  months,  during  which  his  place  was  supplied  by 
Dr.  Guy  C.  Bayley,  he  returned  and  entered  upon  the  duties 
>of  his  office.  He  continued  in  the  faithful  application  of  the 
results  of  his  enlarged  experience  and  observation,  imtil  Au- 
gust 15th,  1837,  when  he  resigned  and  was  succeeded  by  Dr^ 
Benjamin  Ogden.  In  1839,  Dr.  Ogden  resigned,  and  on  the 
1 0th  of  September  of  the  same  year,  was  succeeded  by  Dr. 
William  Wilson.     On   the    1st  of  April,    1844,  Dr.  Wilson 


13 

having  resigned  and  left,  the  place  was  supplied  by  Dr. 
Pliny  Earle. 

When  the  Institution  was  reorganized,  the  Board  of  Gov- 
ernors fixed  upon  the  terms  Physician,  Warden,  and  Matron, 
as  the  designation  of  the  officers.  The  former  Superintendent 
and  his  wife  having  resigned,  Ira  Ford  received  the  appoint- 
ment of  Warden,  and  Mrs.  Ford  that  of  Matron.  They  com- 
menced their  duties  on  the  20th  of  August,  1831,  and  were 
succeeded,  the  former  by  George  B.  Pollock,  on  the  1st  of 
September,  1837,  and  the  latter  by  Mrs.  Ann  Baush,  on  the 
5th  of  the  same  month.  On  the  23d  of  ]March,  1839,  Mr. 
Pollock  left  the  Institution,  and  on  the  9th  of  the  following 
month  was  succeeded  by  William  Boggs,  who  remained  until 
the  1st  of  April,  1843,  when  George  W.  Endicott  entered 
upon  the  duties  of  the  office.  The  Matron,  Mrs.  Baush,  left 
the  Asylum  on  the  5th  of  June,  1840,  and  was  succeeded  by 
Mrs.  Eliza  Hewlett. 

During  the  first  twelve  years  of  the  operation  of  the  In- 
stitution, the  Resident  Physician  acted  as  Apothecary. 
From  the  17th  of  February,  1833,  the  duties  of  that  place 
have  been  performed  by  Jarvis  Titus. 


14 

SECTION  II. 

ON    THE    RECEPTION    OF    PATIENTS. 

On  the  16th  of  June,  1821,  the  first  patient,  a  woman,  was 
admitted.  On  the  20th,  she  was  followed  by  another  woman, 
on  the  23d  by  five  men,  and  on  the  25th  by  one  woman. 
Those  who  were  admitted  on  the  23d  were  transferred  from 
the  Hospital  in  the  City.  In  like  manner  forty-seven  other 
patients,  of  whom  twenty-seven  were  men  and  twenty  wo- 
men, were  soon  afterwards  transferred  from  that  Institution, 
making  the  whole  number  thus  removed,  Males  32,  Females 
20,  Total  52. 

The  following  tables  exhibit,  in  a  condensed  form,  first, 
the  number  of  patients  admitted  during  each  month  and 
year,  from  the  time  of  the  opening  of  the  Asylum  to  the  31st 
of  December,  1844,  a  period  of  twefnty-three  years,  six 
months  and  fourteen  days ; — second,  the  number  of  patients 
discharged,  arranged  in  a  corresponding  manner  ;  third,  the 
daily  average  number  of  patients  actually  resident  in  the 
Asylum  for  each  month  during  the  period  before  mentioned  ; 
fourth,  the  average  daily  residence  for  every  year  ;  and  fifth, 
die  daily  average  number  for  the  whole  period. 


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TABLE  FOURTH. 

Showing  the  mean,  or  average  number  of  Patients  daily  resident  in  the 
Asylum,  fc^  each  Year,  from  June  16, 1S21,  to  December  31,  1844. 


Year. 

A^e.   1   ^-^-  j   A^'^e.     ^-'• 

Daily 
Average. 

1821 

62.80  1  1829    82.81 

1837 

146.29 

1822 

84.75  ll  1830    87.54   1838 

142.64 

1823 

100.92  Ij  1831    95.84   1839   129.65 

1824 

116.53  li  1832    94.02   1840 

129.61 

1825 

120.20  j  1833   106.01    1841   130.14 

1826 

88.26  i  1834   116  78  |  1842 

118.41 

1827 

8998   1835 

132.47  1  1843 

104.36 

1828 

88.68   1836 

151.38  1  1844  1  106.86  | 

The  greatest  average  number  was  in  1836,  when  many  of 
the  patients  were  paupers,  from  the  City  Ahnshouse. 
Daily  average  number  for  the  whole  period. 

The  mean  or  average  daily  number  of  patients  resident  in 
the  Asylum  during  the  whole  period  included  in  the  foregoing 
table,  was  110.44.* 

At  the  time  of  the  opening  of  the  Asylum,  in  1821,  there 
were  but  four  other  public  institutions  exclusively  devoted  to 
the  Insane,  in  the  United  States  ;  but,  during  the  period  over 
which  these  statistics  extend,  the  attention  of  the  commumty, 
in  various  parts  of  the  country,  became  awakened  to  the 
wants  of  that  suffering  class,  and  the  efforts  of  many  indi- 

•  Inasmuch  as  the  method  of  calculating  averages  differs,  to  some  extent,  at 
different  Institutions,  it  may  be  remarked,  that  the  foregoing  were  obtamed  m 
the  only  way  which,  to  us,  appears  to  be  strictly  accurate;  the  monthly  averages 
by  adding  together  the  daily  number  of  patients  for  everyday  in  the  month,  and 
dividing  the  sum  by  the  days  in  that  month;  the  yearly  averages,  by  dividmg 
the  sum  of  all  the  daily  numbers  of  patients  for  the  year,  by  the  number  of 
days  in  the  yean  and  the  average  for  the  whole  period,  by  the  sum  of  all  the 
daily  nnmber  of  patients  from  the  16th  of  June,  1821,  to  t^ie  31st  of  December, 
1844,  by  the  whole  number  of  days  in  that  period. 


20 

viduals  were  actively  directed  to  measures  for  their  relief. 
Hence,  before  the  end  of  the  year  1844,  no  less  than  sixteen 
new  Asylums  were  in  operation,  making  the  whole  number 
in  the  country,  twenty-one.  In  1821,  this  institution  was 
alone  in  the  State  of  New- York,  and  there  was  none  in  the 
neighboring  States  nearer  than  that  at  Hartford,  Conn.,  on 
the  one  hand,  and  that  at  Frankford,  near  Philadelphia,  on 
the  other.  The  extent  of  territory  from  which  it  might  be 
expected  that  the  Bloomingdale  Asylum  would  receive  pa- 
tients, was  consequently  very  large.  The  establishment  of 
new  institutions  necessarily  tended  to  restrict  its  limits.  This 
was  the  fact,  particularly  in  reference  to  the  New- York  City 
Pauper  Asylum,  opened  in  1839,  and  the  New-York  State 
Asylum,  at  Utica,  opened  in  1843.  The  former  took  directly 
from  this  Asylum,  twenty-nine  of  its  inmates,  and  prevented 
any  future  admissions  of  pauper  patients,  from  the  city  ;  and 
the  latter,  occupying  a  central  position  in  the  State,  re- 
ceived from  all  the  inland  and  western  counties  patients,  at 
both  private  and  public  expense,  who  would  otherwise 
have  been  brought  to  Bloomingdale. 

This  explanation  will  account,  in  a  great  measure,  for  the 
fluctuation  in  the  number  of  patients  which  appears  in  the 
foregoing  tables. 

The  Very  sudden  changes  in  the  monthly  average,  at  seve- 
ral dijffercnt  periods,  arose  from  the  simultaneous  admission 
and  discharge  of  many  patients  belonging  to  the  Almshouse 
Department  of  the  City  of  New- York.     Thus 

In  January,  1824,      8  patients  were  brought  from  the  Almshouse. 

In  December,  1825,  *26  patients  were  removed  to  the  Almshouse. 

In  August,  1831,     17         "         "      admitted  from 

In  September,  1831,      8         "         "        "  "  " 

In  October,  1832,     17        "         "     removed  to  " 

*  These,  excepting  the  eight  in  the  preceding  line,  had  been  admitted,  gen- 
erally but  one  at  a  time,  at  various  periods. 


21 

In  July,  1833,  31  patients  were  admitted  from  the  Almshouse. 

InOctobcr,  1834,  iJO        "         "    removed  to  " 

In  January,  1835,  20        "         "     admitted  from  " 

In  July,  1839,  30        "         "     removed  to  " 

During  the  first  three  months  after  the  Asylum  com- 
menced operations,  a  very  considerable  proportion  of  the 
patients  received,  were  from  the  City  Almshouse.  Subse- 
quently, until  1823,  the  increase  in  numbers  was  chiefly  by 
persons  supported  either  by  themselves  or  their  friends,  and 
most  of  them  residing  in  New- York  City  and  its  vicinity. 
From  the  latter  date,  however,  the  Institution  having  be- 
come more  generally  known,  the  counties  in  the  interior  be- 
gan to  send  more  of  their  paupers,  and  there  was  a  corres- 
ponding increase  of  private  pay  patients,  from  remote  dis- 
tances. These  sources  continued  to  furnish  gradually  aug- 
menting numbers  until  the  opening  of  the  State  Asylum  at 
Utica,  as  before-mentioned. 

To  those  who  take  an  interest  in  the  progress  of  the  enter- 
prise for  the  melioration  of  the  condition  of  the  insane,  it 
cannot  fail  to  be  a  source  of  gratification,  that,  as  appears 
by  the  following  statement,  the  accommodations  for  this  af- 
flicted class  are  becoming  far  more  nearly  adequate  to  their 
necessifies. 

On  the  31st  of  December,  1821,  there  were  eighty-two  pa- 
tients at  the  Bloomingdale  Asylum,  the  only  institution  de- 
voted to  the  curative  treatment  of  insanity,  at  that  time 
existing  in  the  State  of  New- York. 

On  3lst  Decem'r,  1844,  there  were  at  the  Bloomingdale  Asylum,  104  pati'ts 
at  the  New-York  State  Asylum,       -     -    260     '• 
at  the  New-York  City  Asylum,      -     -    -  352     " 
at  Dr.  White's  Institution,  Hudson,       -       20     " 
at  Dr.  Macdonald's     "     New- York  City,  15    " 

Total    751    • 


22 

Thus,  in  twenty-three  years,  the  number  of  patients  in  Asy- 
lums increased  from  eighty-two  to  seven  hundred  and  ffty-one. 

At  the  present  time,  July  1847,  the  number  of  patients  in 
the  institutions  just  mentioned,  and  in  one^which  was  opened 
since  1844,  is  as  follows  : — 

Bloomingdale  Asylum,         -        -        -  142 

New-York  State     "...  430 

New- York  City      "   .         .        -        -  417 

Queen's  County,  (Flatbush)  Asylum,  70 

Dr.  White's                                 "        -  20 

Dr.  Macdonald's                         "             -  30 

1,109 

Thus,  more  than  one  thousand  one  hundred  of  the  insane 
are  now  provided  for  at  the  institutions  within  the  State  ; 
and  yet  the  wants  of  the  community  are  not  fully  supplied. 


PART    SECOND. 


THE  PRESENT  STATE  OF  THE  ASYLUM,  AND  ITS  ADMINISTRATION  IN  THS 
MORAL  TREATxMENT  OF  PATIENTS. 


SECTION  L 


OP    THE    BUILDINGS,    GROUNDS    AND    FARM. 

The  Bloomingdale  Asylum  for  the  Insane  is  within  the 
limits  of  the  Municipal  Jurisdiction  of  the  City  of  New- York. 
It  is  on  117th  Street,  between  the  Tenth  and  the  Eleventh 
Avenues,  seven  miles  N.  N.  E.  of  the  City  Hall,  and  about  a 
quarter  of  a  mile  from  the  banks  of  the  Hudson  river,  which 
it  overlooks.  It  is  on  one  of  the  most  elevated  hills  known, 
in  history,  as  the  "  Harlem  heights,"  and  commands  a  pros- 
pect  which,  for  extent,  variety  and  beauty,  is  rarely  equalled 

The  farm  contains  about  fifty- five  ac"res,  and  is  bounded,  on 
its  western  side,  by  the  Bloomingdale  road.  About  thirty 
acres  of  it  is  under  high  cultivation,  portions  being  devoted 
to  grass,  vegetables  and  ornamental  shrubbery. 

The  part  last  mentioned  includes  a  liberal  space,  which  is 
laid  out  and  planted  in  one  of  the  most  approved  styles  of 
English  gardening.  This  having  been  done  in  the  earliest 
years  of  the  Institution,  the  trees,  of  which  there  is  a  great 
variety,  have  many  of  them  attained  their  full  growth  ;  and 
as,  from  year  to  year,  deficiencies  have  been  supplied  and  the 
variety  increased,  the  grounds  will  favorably  compare  with 
most  in  the  country.  In  short,  there  are  but  few,  upon  this 
side  of  the  Atlantic,  which  bear  so  strong  a  resemblance  to 
the  beautiful  homesteads  of  the  wealthy,  in  the  rural,  culti' 
vated  districts  of  England. 


24 

In  thus  perfecting  this  part  of  the  establishment,  the  Go- 
vernors of  the  institution  have  adopted,  and  faithfully  pur- 
sued, that  system  of  moral  regimen  essential  to  the  best 
interests  of  the  insane,  by  avoiding,  as  far  as  possible,  the 
aspect  of  a  prison,  and  surrounding  the  buildings  with  agree- 
able prospects. 

The  principal  edifice  is  constructed  of  reddish  brown  free- 
stone, smoothly  hewn.  It  is  three  stories  high,  besides  the 
basement  and  attic ;  and  consists  of  a  central  portion  and 
two  wings,  the  united  length  of  which  is  two  hundred  and 
eleven  feet.  The  centra]  portion  contains  the  offices  and  the 
private  apartments  for  the  officers.  The  wings  are  occupied 
by  patients,  that  on  the  west  by  men,  and  that  on  the  east  by 
women.  On  each  floor  of  either  wing,  a  hall  or  corridor,  ten 
and  a  half  feet  in  width,  extends  the  whole  length  through 
the  centre,  having  apartments  upon  both  sides.  One  large 
room,  at  the  extremity  of  the  hall,  on  every  floor,  is  used  as  a 
sitting  and  dining  room.  The  others  are  lodging-rooms,  of 
different  dimensions,  sufficient  to  accommodate  from  one  to 
four  beds  each.  There  is  also  a  room  fitted  up  as  a  ward- 
robe, and  one  as  a  water-closet,  on  every  floor  in  each  of  the 
wings,  besides  a  bath-room  on  the  second  story. 

Parallel  with  the  western  extremity  of  this  edifice,  and 
about  one  hundred  and  fifty  feet  in  its  rear,  there  is  another 
bnilding,  constructed  of  brick,  fifty-seven  feet  long,  thirty-two 
feet  eight  inches  wide,  and  three  stories  high  ;  the  corridors 
are  ten  feet  wide,  and  the  rooms  are  mostly  of  uniform  size, 
being  nine  feet  tAVo  inches  in  length  by  seven  feet  two  inch- 
es in  width.  In  the  rear  of  the  eastern  extremity  of  the  prin- 
cipal edifice,  and  parallel  with  the  building  just  described, 
stands  a  third,  the  basement  of  which  is  a  laundry,  while  the 
upper  two  stories  are  occupied  by  female  patients.  It  is  sixty- 
£ix  feet  six  inches  long,  by  thirty-eight  feet  wide.  The  corri- 
dors are  nine  feet  six  inches  wide,  and  the  patients'  rooms 
nine  feet  six  inches  long,  by  six  feet  six  inches  wide. 


S5 

There  are  six  bathing  rooms  in  the  establishment — two  of 
which  have  ah'eady  been  mentioned.  There  is  one  in  the 
basement  of  each  wing  of  the  principal  edifice,  and  one  in 
each  of  the  smaller  buildings. 

The  water  used  in  the  Asylum  is  obtained  from  wells  and 
springs,  together  with  what  is  collected  from  the  roofs.  Se- 
veral subterranean  cisterns,  and  six  tanks  in  the  attic  of  the 
main  building,  each  holding  thirteen  hogsheads,  are  the  re- 
servoirs for  that  which  is  collected  from  the  source  last  men- 
tioned. 

Every  department  occupied  by  patients  is  heated  by  air  fur- 
naces, with  the  exception  of  the  sitting  and  dining  rooms,  in 
the  principal  building;  in  each  of  which  there  is  a  coal  fire, 
in  either  a  grate  or  a  stove.  CcJal  is  the  principal  fuel  used 
in  the  establishment.  The  annual  consumption  is  about  two 
hundred  tons.  Most  of  the  water  used  in  domestic  purposes, 
and  all  that  is  used  in  the  washing  of  clothes,  is  heated  by 
steam. 

There  are  two  kitcRens,  one  for  the  oflicers,  the  other  for 
the  rest  of  the  household.  Fourteen  tables  are  set  at  each 
meal,  one  for  the  officers,  ten  for  the  patients,  and  three  for 
the  domestics. 

The  principal  out-buildings  on  the  premises  are  a  barn,  in- 
cluding stables  and  carriage-house,  an  ice-hou&e,  and  a  green- 
house, or  conservatory.  The  barn  is  large  and  built  of  stone, 
in  the  most  substantial  manner.  The  green-house  contains 
about  seven  hundred  plants,  many  of  them  rare  and  beautiful 
exotics. 


SECTION  II. 

MORAL    TREATMENT. 

In  the  moral  regimen  at  this  institution,  every  practicable 
effort  is  made  to  pursue  that  system,  at  once  gentle,  philoso- 
phical and  practical,  which  has  resulted  from  the  active  and 
strenuous  endeavors  of  many  philanthropists,  in  the  course 
of  the  last  half  century,  to  meliorate  the  condition  of  the  in- 
sane. The  primary  object  is  to  treat  the  patients,  so  far  as 
their  condition  will  possibly  admit,  as  if  they  were  still  in  the 
enjoyment  of  the  healthy  exercise  of  their  mental  faculties. 
An  important  desideratum  for  the  attainment  of  this  object  is, 
to  make  their  condition,  as  boarders,  as  comfortable  as  possi- 
ble ;  that  they  may  be  the  less  sensible  of  the  deprivations  to 
which  they  are  subjected  by  a  removal  from  home.  Nor  is 
it  less  essential  to  extend  to  them  the  privilege,  or  the  right, 
of  as  much  liberty,  as  much  freedom  from  personal  restraint 
as  is  compatible  with  their  safety,  th(i  safety  of  others,  and 
the  judicious  administration  of  other  branches  of  curative 
treatment.  The  courtesies  of  civilized  and  social  life  are  not 
to  be  forgotten,  tending,  as  they  do,  to  the  promotion  of  the 
first  great  object  already  mentioned,  and  operating,  to  no 
inconsiderable  extent,  as  a  means  of  effecting  restoration  to 
mental  health. 

The  means  generally  included  in  what  is  termed  moral 
treatment,  although  many  of  them  operate  upon  the  mind  by 
increasing  the  physical  activity  and  energy,  will  be  described 
under  their  respective  heads. 

I.    MANUAL    LABOR. 

Some  employment  for  the  hands,  of  a  description  requiring^ 
a  degree  of  exercise  of  the  body  sufficient  to  preserve  and  in- 
crease the  activity  and  vigor  of  all  its  organs,  as  well  as  to 


27 

promote  sound  and  healthful  sleep,  is  acknowledged,  by  all 
who  are  conversant  with  the  treatment  of  insanity,  as  it  ap- 
pears in  public  institutions,  to  be  the  most  effectual  of  resto- 
rative measures  not  purely  medical.  Hence,  some  phj^sicians 
have  recommended  compulsory  labor,  in  cases  where  the  pa- 
tient will  not  engage  in  it  voluntarily. 

At  this  As^-lum  the  patients  are  advised  and,  if  possible, 
induced  to  apply  themselves  to  some  useful  occupation,  but 
no  compulsory  measures  are  resorted  to  for  the  purpose  of 
enforcing  it. 

A  large  proportion  of  the  inmates,  as  will  be  perceived 
by  the  table  of  occupations,  are  from  the  classes  unaccustom- 
ed to  manual  labor.  These,  with  very  rare  exceptions,  will 
never  commence  any  employment  of  the  kind,  while  at  the 
Asylum. 

Another  large  class  of  the  patients  are  mechanics  and  ar- 
tisans, from  the  city,  unaccustomed  to  any  occupation  other 
than  that  to  v/hich  they  were  bred,  and  facilities  for  pursu- 
ing which  cannot,  in  most  cases,  be  furnished  here  or  at  any 
similar  institution. 

Finally,  of  those  who  are  acquainted  with,  and  habituated 
to  such  kind  of  labor  as  can  be  introduced  here,  a  considerable 
proportion  are  rendered  unfit  to  work  by  their  disease  ;  and 
others,  though  able,  will  not  work,  because — to  them  appa- 
rently the  best  of  all  reasons, — they  "  pay  their  board." 

With  all  these  adverse  influences,  it  cannot  be  expected 
that,  in  an  institution  accommodating  but  about  seventy- five 
of  either  sex,  the  number  should  be  large  who  devote  much 
of  their  time  to  labor.  There  are  some,  however,  who  work 
upon  the  farm,  and  others  in  the  carpenter's  shop,  the  kitch- 
en and  the  laundry  ;  while  numerous  small  jobs  about  the 
establishment  furnish  employment  to  a  considerable  number 
of  the  men. 

A  much  larger  proportion  of  women  than  of  men  labor  vo- 


28 

luntarilj',  not  only  because  all  classes  of  women,  in  this  coun- 
try, are,  with  but  few  exceptions,  taught  to  use  the  needle, 
but  because  this  species  of  labor  is  one  which  can  be  intro- 
duced into  the  apartments  of  the  patients. 

Could  some  light  occupation,  requiring  but  little  mechani- 
cal ingenuity  or  skill,  be  carried  on  in  all  the  wards  of  the 
men's  department,  the  number  of  laborers  on  that  side  might 
be  materially  augmented. 


II.    RELIGIOUS    WORSHIP. 

It  is  believed  that  the  first  attempt,  in  the  United  States, 
to  hold  a  meeting  for  religious  worship  in  an  institution  for 
the  insane,  was  made  at  the  Lunatic  Asylum  adjoining  the 
New- York  Hospital, — the  building  for  which  the  Blooming- 
dale  Asylum  was  erected  as  a  substitute.  On  the  31st  of 
August,  1819,  the  Rev.  John  Stanford,  a  venerable  Divine 
who  will  long  be  remembered  for  his  active  benevolence, 
preached  a  sermon  to  the  inmates  of  that  institution, — an  oc- 
casion to  which  he  alludes,  in  the  following  manner,  in  the 
writings  published  in  his  memoir. 

"About  forty  of  the  most  composed  of  the  patients  were 
assembled,  and  several  of  the  Governors,  the  Physicians  of 
the  house,  and  the  Superintendent  of  the  Hospital  attended 
on  the  occasion.  The  patients  conducted  with  great  pro- 
priety, and  many,  of  their  own  accord,  kneeled  while  prayer 
was  offered,  and  several  expressed  their  thanks  at  the  close 
of  the  service." 

In  the  year  1832,  a  Chaplain  was  employed  at  the  Bloom- 
ingdale  Asylum,  and  regularly,  since  that  time,  such  patients 
as  were  suitable  have  assembled,  on  the  sabbath,  for  divine 
worship.  With  one  hundred  and  forty  patients  in  the  Asy- 
lum, the  average  number  in  attendance  is  about  eighty-five. 
Their  deportment,  with  few  and  rare  exceptions,  is  charac' 


29 

terized  by  good  order,  decorum,  and  a  regard  to  the  proprie- 
ties of  the  place  and  the  object  of  the  assembly. 

To  a  large  majority  of  the  patients  these  services  are  be- 
neficial. To  a  few,  such  as  are  very  melancholy,  disposed  to 
excessive  contemplation  upon  religious  subjects,  and  hopeless 
of  salvation  for  themselves,  the  tendency  is  thought  to  be  in- 
jurious, and  they  are  consequently  not  permitted  to  attend. 

III.    RECREATIVE    EXERCISE. 

a.  Importance  of  Exercise. — A  considerable  portion  of  the 
insane  are  impatient  of  detention  and  of  any  abridgement  of 
their  personal  independence  of  action.  Another  portion,  quite 
as  large,  especially  in  institutions  that  have  been  in  opera- 
tion many  years,  are  inactive,  stupid,  and  disposed  to  be 
constantly  sitting  or  lying  down.  To  gratify  the  former,  to 
rouse  the  latter,  and  as  a  hygienic  measure  for  all,  it  is  in- 
tended, at  this  Asylum,  that  every  patient  capable  of  leaving 
the  house  shall  have  a  certain  degree  of  exercise,  dail}^  out  of 
doors.  Hence,  after  the  morning  visit  of  the  Physician,  and 
again  after  dinner,  such  patients  as  are  allowed  the  liberty 
of  the  premises,  go  out  unattended,  and  all  the  others  in  the 
men's  department  are  transferred  to  the 

h.  Airing  courts  or  yards. — There  are  three  of  these  for  the 
men,  and  four  for  the  women.  They  are,  with  one  exception, 
well  shaded  with  trees,  and  three  of  them  have  large  bowers, 
covered  with  roofs,  and  furnished  with  seats  for  all  the  pa- 
tients admitted  into  the  courts. 

An  opinion  unfavorable  to  airing  courts  has  been  ex- 
pressed by  several  eminent  Physicians  connected  with  Asy- 
lums in  the  United  States.  The  principal  objections  which 
have  been  urged  against  them  are,  first,  their  prison-like  as- 
pect, and  second,  the  patients  admitted  into  them  are  liable 
to  lie  upon  the  ground,  and  thereby  injure  their  health. 


30 

The  first  objection  is  easily  answered.  The  airing  courts 
at  the  Retreat,  near  York,  England,  at  the  York  Lunatic 
Asylum,  and  at  some  of  the  other  institutions  in  Europe,  have 
a  mucli  stronger  resemblance  to  a  beautiful  garden  than  to 
the  yard  of  a  penitentiary.  It  is  an  old  adage,  true  as  trite, 
that  "  what  man  has  done  man  may  do,"  and  if  the  courts  of 
foreign  institutions  can  be  made  so  cheerful  and  attractive, 
there  is  no  obstacle  sufficient  to  prevent  the  attainment  of  the 
same  object  in  the  United  States. 

The  second  objection  may  be  as  easily  met.  At  this  Asy- 
lum, the  courts  occupied  by  the  men  are  kept  constantly  un- 
der observation,  by  an  attendant  whose  time  is  devoted 
to  this  purpose  ;  and  among  the  rules  by  which  he  is  to  go- 
vern his  conduct,  are  the  following  : — 

"  He  must  see  that  each  patient  has  a  hat,  while  in  the 
yard,  and  that  the  clothes  of  all  are  kept  properly  arranged, 
the  pantaloons,  vest,  and  shirt-collars  buttoned. 

"  He  must  not  permit  the  patients  to  lie  on  the  ground  while 
in  the  yard ;  but  must  endeavor  to  amuse,  encourage  and 
assist  them  in  their  games." 

The  Physicians  who  object  to  yards  or  courts,  advocate,  as 
a  substitute,  open  verandahs,  guarded  by  lattice-work,  such 
as  are  found  at  the  Massachusetts  State  Lunatic  Hospital,  and 
at  some  of  the  other  institutions  of  this  country.  It  appears 
to  us  that,  to  the  minds  of  the  patients,  these  must  be  much 
more  constantly  suggestive  of  imprisonment,  or  confinement, 
than  a  large,  well  shaded,  cultivated  court.  And  it  is  pre- 
sumed that  no  one  will  endeavor  to  maintain  that  the  ex- 
ercise to  be  obtained  in  a  necessarily  restricted  space,  upon 
a  floor,  can  be  so  conducive  to  health  as  that  which  is  gain- 
ed in  a  court  of  liberal  dimensions,  in  the  open  air,  and  upon 
the  ground. 

The  most  approved  and  best  of  hygienic,  or  of  curative 


31 

measures,  may  be  badly  managed ;  but  it  needs  no  argu- 
ment to  prove  that  the  abuse  of  a  thing  should  prevent  the 
use  of  it  in  a  judicious  manner, 

c.  Walking-. — One  attendant  devotes  his  time,  at  suita- 
ble hours  in  the  day,  to  walking  with  the  men,  over  the 
premises  and  throughout  the  neighbouring  country ;  and  all 
the  attendants,  of  both  sexes,  are  required  to  walk,  daily, 
with  some  of  the  patients  under  their  care.  They  frequent- 
ly make  excursions  of  several  miles,  visiting  the  Receiving 
Reservoir  of  the  Croton  Water,  the  High  Bridge,  or  aque- 
duct intended  to  convey  that  water  over  the  Harlem  River, 
the  Trinity  Church  Ccmetry  and  other  places  of  interest  in 
the  vicinity. 

In  the  proper  season,  some  are  permitted  to  go  to  the 
neighboring  river  to  bathe  or  to  fish. 

d.  Riding. — Two  horses,  and  a  carriage  with  seats  for 
eight,  are  wholly  devoted  to  the  use  of  the  patients.  They 
go  out  regularly,  in  suitable  weather,  from  two  to  four  times 
a  day,  taking  the  patients  in  rotation.  They  go  from  six 
to  eight  miles  at  each  excursion,  the  direction  being  varied, 
as  much  as  the  many  roads  and  streets  in  the  vicinity  will 
allow. 

IV.    INSTRUCTION. 

a.  Lectm^es. — Soon  after  the  writer  of  this  article  first  di- 
rected his  attention  to  the  treatment  of  the  insane,  he  became 
convinced  that  lectures  upon  scientific  and  miscellaneous 
subjects  might  be  made  an  object  of  interest,  as  well  as  of 
utility,  in  the  moral  treatment  of  patients  in  public  institu- 
tions. Accordingly,  being  at  that  time  connected  with  the 
Frankford  Asylum,  near  Philadelphia,  he  induced  the  mana- 
gers of  that  institution  to  purchase  an  air-pump  and  other 
philosophical  apparatus,  and  with  the  aid  of  these  he  gave 
a  series  of  experimental  lectures  before  the  patients,  in  the 


32 

winter  of  1840-41  ;  and  again  in  the  winter  of  1841-42.  The 
results  were  as  favorable  as  had  been  anticipated. 

The  writer  became  connected  with  the  Bloomingdale  Asy- 
lum in  the  spring  of  1844,  and  in  the  autumn  of  the  same 
year,  encouraged  by  the  Governors,  who  made  a  liberal  ap- 
propriation for  the  purchase  of  apparatus,  commenced  a 
course  of  lectures,  which  were  continued  through  the  winter. 
The  success  was  sufficient  to  induce  perseverance  in  the  plan, 
and  a  similar  course  has  been  delivered  in  each  succeeding 
year  since  that  time.  The  last  commenced  on  the  12th  of 
October,  1846,  and  ended  on  the  3rd  of  May,  1847.  It  con- 
sisted of  thirty-eight  lectures,  as  follows  : 

Natural  Philosophy,         .         .         .         Four  Lectures. 

Chemistry,  .         -         -         Sfx         do. 

Animal  Physiology,  -         .         .         Nine      do. 

Astronomy,  -         -         -     '    Ten        do. 

Physical,  Intellectual  and  Moral  Beauty,  Two      do. 

Recitations  of  Poetry,       -         -         -         One       do. 

History  and  description  of  Malta,      -         Two     do. 

Greece  as  it  was  in  1838,  -         Two      do. 

Characteristics  of  the  Americans 


1  t:.  (  Two      do. 

and  liUropeans, 

For  the  suitable  illustration  of  the  lectures,  the  Institution 
is  furnished  with  the  following  apparatus: 

1st.  An  Air-pump,  with  its  accompaniments. 

2nd.  A  set  of  Mechanical  Powers. 

3rd.  A  Magic  Lantern. 

4th.  An  Orrery. 

5th.  An  Electrical  Machine,  with  its  implements. 

6th.  Pneumatic  Trough,  Receivers,  Retorts  and  other  ar- 
ticles used  in  Chemistry. 

7th.  One  hundred  and  forty-six  diagrams,  painted  upon 
bleached  muslin,  illustrative  of  the  structure  of  the  human 
frame,  and  that  of  the  lower  orders  of  animals. 


33 

8th.  Twenty  similar  diagrams  explanatory  of  the  laws  and 
phenomena  of  light. 

9th.  Twenty-five  Astronomical  diagrams. 

10th.  One  hundred  diagrams  illustrating  various  subjects. 

The  lectures  were  delivered  in  the  evening,  and  attended 
by  an  average  number  of  about  seventy  patients.  Their 
attention  and  deportment  would  compare  favorably  with 
that  of  the  audi(»nces  ordinarily  attendant  upon  lectures. 

It  will  be  perceived  that  such  subjects  were  selected  as 
are  susceptible  of  demonstration  or  illustration,  experimen- 
tally, or  through  the  medium  of  diagrams.  Such  topics  are 
considered  as  the  most  suitable,  inasmuch  as  the  perceptive 
faculties  are  called  into  action  by  addressing  the  eye,  as  well 
as  the  ear.  As  a  general  rule,  this  holds  good ;  but  of  all  the 
lectures  mentioned  in  the  foregoing  list,  it  is  believed  that 
none  commanded  more  profound  attention,  or  gave  more  ge- 
neral satisfaction,  than  that  which  consisted  of  the  recitation 
of  poetry,  with  remarks  upon  the  character  of  the  pieces,  and 
upon  the  authors  by  whom  they  were  written. 

As  a  simple  method  of  exerting  disciplinary  restraint, 
simultaneously,  over  a  large  number  of  patients  ;  a  means  of 
fixing  the  attention  and  withdrawing  the  minds  of  compara- 
tively a  multitude  from  the  delusions  incident  to  their  disease, 
we  believe  there  is  no  other  plan,  hitherto  adopted  in  the  sys- 
tem of  moral  treatment,  which  will  prove  more  generally 
and  extensively  useful  than  that  of  judicious  and  well 
managed  lectures. 

h.  School. — In  the  autumn  of  1845,  a  school  was  commenced 
in  the  men's  department,  and  continued  until  the  following 
spring.  It  was  suspended  during  the  summer,  but  again 
opened  and  kept  during  the  winter  of  1846-47.  It  was  at- 
tended by  from  twenty  to  thirty  patients,  of  various  ages  and 
in  a  diversity  of  conditions,  in  regard  to  mental  disorder. 
The  ordinary  English  branches  were  taught,  and  in  these 


34 

some  of  the  younger  patients  made  considerable  progress. 
Others  reviewed  what  they  had  previously  studied,  and  others 
still,  interested  or  amused  themselves  by  reading  from  enter- 
taining books  and  newspapers. 

It  is  not  to  be  expected  that  great  advancement  in  valuable 
knowledge  can  ever  be  attained  in  a  school  for  the  insane. 
The  only  object  generally  within  reach,  and  the  only  one  the 
acquisition  of  w^hich  need  be  expected — and  this  indeed  is 
much — is  the  exercise  of  a  moral  control  over  large  numbers 
at  once  ;  subduing  excitement,  rousing  the  inactive,  and  giv- 
ing a  new  current  to  the  thoughts. 

c.  Library. — A  miscellaneous  library  of  about  one  thousand 
volumes  is  devoted  to  the  use  of  the  patients,  and  five  daily 
and  eight  weekly  newspapers,  two  monthly  magazines  and 
four  quarterly  reviews  are  also  taken  for  them.  Thus  an  in- 
exhaustible fund  of  reading  is  supplied,  and  a  librarian  distri- 
butes it  to  such  patients  as  are  disposed  to  make  use  of  it. 

V.    AMUSEMENTS. 

a.  Games. — Facilities  for  various  diversions  are  afforded 
to  the  patients.  A  bowling  alley,  or  nine-pins,  holds  the 
first  rank  among  the  means  of  this  species  of  moral  treat- 
ment, whether  we  regard  its  utility,  or  the  number  of  patients 
who  resort  to  it  for  amusement.  The  interest  of  the  game 
renders  it  sufficiently  attractive  and  absorbing,  while  the 
physical  force  required  furnishes  no  small  amount  of  whole- 
some exercise.  Quoits,  the  bat-ball,  the  foot-ball  and  the 
swing  are  the  other  principal  means  of  amusement  out  of 
doors. 

Within  the  house,  we  have  bagatelle,  battle-door,  "  the 
graces,"  chess,  chequers,  backgammon,  cards  and  various 
other  games. 

h.  Music. — A  piano,  viol,  violin,  bugle,  drum,  flutes  and  fifes 
are  accessible  to  such  as  have  a  taste  for  music. 


35 

c.  Parties. — On  one  eveninj^  in  each  week,  during  the  cold 
season,  the  convalescent  and  convalescing  patients,  to  the 
number  of  from  ten  to  fifteen  of  each  sex,  are  invited  into  a 
parlor  in  the  central  building,  where,  in  company  with  the 
officers,  they  pass  a  few  hours  sociably,  or  engaged  in  such 
games  as  may  be  introduced.  Refreshments  are  supplied, 
and  in  this,  as  well  as  in  other  respects,  these  parties  differ 
but  little  from  similar  assemblies  in  private  houses. 

d.  Dancing. — On  one  evening  in  each  month,  during  the  cold 
season,  there  is  a  cotillion  party,  or  ball,  attended  by  from 
sixty  to  seventy  of  the  patients.  No  means  of  entertainment 
gives  more  general  satisfaction  than  this  ;  and,  on  the  class 
of  patients  admitted  herfe,  its  general  influence  is  evidently 
beneficial. 

VI.    RESTRAINTS. 

Since  the  establishment  of  this  institution,  the  opinions  of 
those  concerned  in  the  management  of  the  insane  have 
passed  through  a  variety  of  phases,  in  regard  to  the  extent 
to  which  corporeal  restraint  and  other  coercive  measures  are 
necessary,  in  the  proper  management  of  patients.  From  the 
ultra  ideas  of  the  old  regime,  in  which  the  discipline  of  an 
institution  of  this  kind  was  almost  identical  with  that  of  a 
common  jail,  and  in  some  instances  even  ^vorse,  there  has 
been  a  gradual  but  constant  mitigation  of  severity,  in  both 
theory  and  practice,  until  the  opposite  extreme  has  been 
reached,  and  the  doctrine  of  the  entire  abolition  of  the  use 
of  restraining  appliances  for  the  body  or  limbs,  has  been 
promulgated  as  that  which  alone  is  compatible  with  the  true 
interests  and  the  judicious  treatment  of  the  insane.  Keep- 
ing pace,  to  a  certain  point,  with  this  progressive  sentiment, 
and  directed  by  the  surest  of  all  guides,  the  light  of  experi- 
ence, the  executive  officers  of  this  institution   have   gradu- 


3G 

ally  abandoned   the  most  exceptionable    forms  of  restraint, 
and   more  rarely  resorted   to   those  of  a  milder   character. 
They  have  never,  however,    become    proselytes   to  the  doc- 
trine of  the  absolutely  entire  disuse  of  all  restraining  appa- 
ratus.    There  are  exceptions  to  all  rules  which  are  not  gov- 
erned by  the  invariable   laws  of  mathematics  or  of  moral 
right,  and    no  argument,  however  subtle  or  specious,  or,  to 
appearances,  however  strongly  based,  theoretically,  upon  be- 
nevolence, philanthropy,    kindness,    and  the    golden   rule  of 
"  doing  to  others  as  we  would,  under  similar  circumstances, 
that   they  should  do   unto   us,"  can    overthrow  our  belief — 
founded  upon  the  observation  of  several  years, — that  there  are 
cases  in  which  the  welfare  of  the  patient,    and  the  dictates 
of  true  humanity,  require  a  resort  to  some  restraining  means. 
The  truth  of  this  proposition   may  be,    and   perhaps   is,   ac- 
knowledged by  all.     Yet  those  who,  in  their  recession  from 
left  hand  defections,  have,  in  our  judgment,  fallen  into  right 
hand  errors,  assert  that,  in  the  cases  alluded  to,  whatever  re- 
straint is  applied  should  be  that  of  the  hands  of  the  attend- 
ants.    To  this   substitute,  or   subterfuge,   we  cannot  resort, 
knowing,  as  we  do,  the  greater  irritation  produced  in  a  pa- 
tient, by  being  held  by  the  hands  of  attendants,  than  by  hav- 
ing his   limbs  confined  by  mechanical  appliances.     In  the 
former,  mind  struggles  with  mind  ;  in  the  latter,  with  matter 
alone.     The  only  means  of  restraint  now  used  in  the  Asy- 
lum are  the  camisole,  or  long  sleeves,  leathern  muffs  for  the 
hands,  and  the  invaluable  apparatus,  invented  by  Dr.  Rufus 
Wyman,  for  confining  a  patient  in  bed. 

The  camisole  is  in  nearly  all  cases  sufficient.  During  the 
last  three  years,  the  muffs  have  not  been  used  in  more  than 
two  or  three  cases  annually,  and  in  those  for  but  a  day  or 
two,  or,  at  most,  but  a  few  days  each.  There  was  one  peri- 
od of  thirteen  months,  during  which  restraint  was  resorted  to 
but  in  two  cases  in  the  men's  department.     In  one  of  these 


.1 


37 

the  patient,  while  in  a  condition  of  typhoid  delirium,  wore  a 
camisole  three  days,  and  in  the  other,  the  patient's  hands 
were  similarly  confined,  a  few  hours,  to  ensure  the  vesication 
of  a  blister. 

We  have  found  that  the  proportion  of  women  requiring  re- 
straint is  greater  than  that  of  men  ;  and  in  this  it  is  believed 
that  our  experience  coincides  with  that  of  Physicians  of 
other  institutions. 

In  no  less  than  three  cases,  in  which  there  was  prolonged 
and  exhausting  excitement,  we  are  convinced  that  Wyman's 
bed  apparatus  has  been  the  means  of  insuring  sleep,  and  of 
saving  the  life  of  the  patient.  It  is  a  method  of  restraint 
with  which  every  institution  should  be  supplied. 

VII.  ATTENDANTS. 

It  requires  but  little  experience,  in  an  Asylum,  to  convince 
a  person  of  the  identity  between  a  judicious  parental  govern- 
ment, and  that  system  of  management  which  is  best  adapted 
to  the  insane.  The  motives,  the  influences,  and,  as  a  general 
rule,  the  means  necessary  for  the  good  government  of  chil- 
dren, are  equally  applicable,  and  equally  efficient  for  the  in- 
sane. In  fact,  this  system  is  the  great  desideratum,  at  every 
Asylum ;  and  without  it,  it  is  impossible  for  the  management 
to  approximate  that  degree  of  perfection  which  it  is  desirable 
to  attain. 

The  most  essential  element  of  success  in  the  establish- 
ment and  maintenance  of  such  a  government,  is  a  corps  of 
intelligent  attendants,  of  kind  disposition,  and  good  judg- 
ment. Such  and  such  alone  can  sustain  a  disciplinary  code, 
founded  upon  kindness  and  supported  with  firmness. 

Much  pains  has  been  taken,  at  this  institution,  to  procure 
attendants  of  this  character,  and,  especially  as  regards  the 
men's  department,  the  efforts  have  been  rewarded  with  a 
good  degree  of  success.     Nearly  all  the  young  men  who 


38 

have  been  so  employed  during  the  last  few  years,  were  from 
the  country,  and  so  well  educated  that  they  had  been  accus- 
tomed to  teaching  school  in  the  winter. 

It  is  needless  to  describe,  in  detail,  the  numerous  advanta- 
ges of  attendants  of  this  kind  over  those  who  are  ignorant, 
and  whose  only  ideas  of  exerting  control  over  others,  are 
measured,  by  the  strength  of  their  arms.  He  who  has  once 
tried  the  former,  would  greatly  deplore  the  exigency  which 
should  render  it  necessary  to  return  to  the  latter. 

Such  are  the  principal  facilities  afforded  for  moral  treat- 
ment at  this  Asylum.  They  are  sufficiently  extensive,  if 
frequently  called  into  requisition,  not  only  to  break  the  mo- 
notony of  hospital  life,  and  promote  the  contentment  of  the 
patients,  but  also  to  effect  much  towards  the  accomplish- 
ment of  the  great  object  of  the  institution — the  instalment 
of  reason  upon  the  seat  from  which  it  has  been  dethroned. 


PART   THIRD. 


AN  ANALYSIS  OF  THE  CASES  ADMITTED  INTO  THE  ASYLUM  PREVIOUSLY 
TO  DECEMBER  31st  3844. 


CHAPTER  I. 

CASES     OF     DELIRIUM     TREMENS. 
SECTION    I. 

Of  the  Number  of  Patients  Admitted. 

During  the  whole  period  of  its  existence,  the  Asylum  has 
been  made  the  receptacle,  not  for  cases  of  insanity  proper 
alone,  but  also  for  persons  laboring  under  Delirium  tremens, 
as  well  as  for  some  who,  although  not  attacked  with  this  dis- 
ease, were  addicted  to  the  habitual  and  excessive  use  of  in- 
toxicating liquors.  These  persons  are  not,  strictly  speaking, 
proper  subjects  for  an  Asylum  for  the  insane  ;  but  as  there  is 
no  institution  in  the  vicinity  of  New- York  particularly  in- 
tended for  them,  and  no  other  place  so  well  adapted  to  their 
treatment,  and  temporary  seclusion  from  the  sources  of  their 
disorder,  in  the  hope  of  a  reformation,  this  establishment  al- 
most necessarily  became  their  place  of  refuge. 

The  aggregate  number  of  cases  of  this  kind,  admitted  pre- 
viously to  the  31st  of  December,  1844,  is  594,  of  which  511 
were  males  and  83  females.  But  this  number  includes 
many  re-admissions  of  the  same  individuals.  In  the  sub- 
joined table,  these  cases  are  arranged  according  to  their  se* 
veral  admissions  and  re-admissions. 


40 


Males. 

Females. 

Total. 

First  Admission, ......  ........ 

274 

85 

42 

29 

20 

14 

8 

5 

5 

5 

5 

3 

2 

2 

12 

48 
17 
7 
4 
3 
2 
2 
0 
0 
0 
0 
0 
0 
0 

0 

322 

102 

49 

33 

23 

16 

10 

6 

5 

5 

5 

3 

2 

2 

12 

Second  Admission, 

Th'rd  Admission 

Fourth  Admission, 

Fifth  Admission, 

Sixth  Admission 

Seventh  Admission,  ........... 

Eighth  Admission, 

Ninth  Admission  ............. 

Tenth  Admission, 

Eleventh  Admission, 

Twelfth  Admission 

Thirteenth  Admission, 

Fourteenth  Admission, 

From  loth  to  26ta,  each  one  Ad- 
mission,   

Total 

511 

83 

594 

SECTIONII. 

Of  First  Admissions. 

From  the  foregoing  table  it  appears  that  the  whole  num» 
ber  of  persons  in  this  class  is  322.  To  these,  and  to  their 
disease  on  their  first  admission,  our  investigations  must,  for 
the  present,  be  confined.  The  years  in  which  they  were  res- 
pectively first  admitted,  are  indicated  in  the  following  table : — ■ 


Year 

Males. 

Femal 

Total. 

Year. 

Males. 

Femal. 

Total. 

Year. 

Miller. 

Femal. 

Total. 

182] 

14 

0 

14 

B'tnp 

145 

22 

167 

B't  up 

238 

35 

273 

1822 

19 

3 

22 

1830 

9 

4 

13 

1838 

9 

0 

15 

1823 

14 

4 

18 

1831 

14 

1 

15 

1839 

4 

1 

5 

1824 

17 

0 

17 

1832 

12 

1 

13 

1840 

5 

2 

7 

l!:25 

24 

3 

27 

1833 

17 

1 

18 

1841 

6 

1 

7 

1826 

20 

5 

25 

1834 

11 

1 

]2 

1842 

2 

2 

4 

1627 

14 

5 

19 

lo35 

5 

3 

8 

1843 

4 

1 

5 

1828 

11 

2 

13 

1836 

12 

1|      13 

1844 

G 

0 

6 

i82ii 

12 

0 

12 

1837 

13 

1 

14 

CM  up 

145 

22 

167 

C'd  np 

238 

35 

273 

Tol'i 

274 

48 

322 

41 


In  the  earlier  years  of  the  institution,  as  will  be  perceived 
by  this  schedule,  many  more  intemperate  persons  were 
received,  than  at  a  later  period,  although  the  population 
of  the  City,  the  principal  source  of  the  patients,  was  more 
than  doubled  during  the  years  to  which  these  statistics  refer. 
This  fact  may  undoubtedly  be  in  part  attributed  to  impro- 
ved habits,  resulting  from  the  interest  awakened  in  the  cause 
of  temperance. 

The  sexes  being  distinguished  in  the  foregoing  table,  it  will 
be  perceived  that  there  were  274  males,  and  48  females ;  the 
former  exceeding  the  latter  in  the  proportion  of  nearly  6  to  1. 

Of  these  322  patients,  the  countries  of  nativity  of  273,  and 
those  of  residence,  at  the  time  of  admission,  of  294,  are  re- 
corded.    They  are  as  follows  : — 


NATIVITY. 

State. 

Males. 

Fema. 

Total. 

Country. 

Males. 

Fema. 

Total. 

New- York, 

Connecticut, 

New  Jersey,.. . 
Massachusetts,  . 
Pennsylvania, . . 

Maryland,  ,^ 

Virginia, 

Maine, . ., 

New  Hampshire 
Rhode  Island,.. 
S.  Carolina, 

137 
10 
9 
7 
2 
2 
2 
1 
0 
1 
0 

15 
1 
0 
1 
I 
0 
0 
0 
1 
0 

1 

152 
11 
9 
8 
3 
2 
2 
1 
1 
1 
1 

192 

Ireland, 

|England,  . 

Scotland, 

France, ~. 

Nova  Scotia, 

Wales, ......... 

32 
14 
7 
2 
1 
1 
1 
1 

13 
6 
1 
1 

1 
0 
0 
0 

45 
20 
8 
3 
2 
1 
1 
1 

Germany, 

Sweden  .. .  .. 

Total  Foreigners, 
Total  U.    States, 

59 
172 

22 
20 

81 
192 

Total  U.  States, 

172 

20 

Aggregate 

231 

42 

273 

RESIDENCE. 

State  or  Country. 

Males. 

Fema. 

Total. 

State  or  Country 

Males. 

Fema. 

Total. 

New- York..,..  . 

New  Jersey 

Massachusetts,  . 
Connecticut  .. . 
Pennsylvania  . . 

237 
6 
4 
3 
0 

39 
0 
0 
0 
1 

276 
6 
4 
3 
1 

Brought  up 

Virginia 

Louisiana 

Michigan 

Canada  ..  ► 

250 
0 
1 
1 
1 

40 
1 
0 
0 
0 

290 

1 
1 
1 

1 

Cariied  up  .  .^  . 

250 

40 

290 

Total -  - 

253 

41 

294 

42 


It  appears  that  152,  or  55  per  cent  of  the  whole,  were  born 
in  the  State  of  New- York  ;  and  40,  or  14  per  cent,  were  na- 
tives of  other  States  of  the  Union.  Of  foreigners  there  were 
81,  which  is  equal  to  30  per  cent. 

Persons  laboring  under  Delirium  tremens  are  rarely  car- 
ried to  a  great  distance  for  treatment.  This  is  rendered  in- 
convenient, and  generally  impossible,  both  by  the  condition 
of  the  patient  and  the  duration  of  the  disease. 

Hence  it  is  not  surprising  that,  of  295  individuals  admitted, 
no  less  than  276  resided  in  this  State  ;  and  a  very  large  pro- 
portion of  these  in  the  City  of  New- York.  Of  the  19  whose 
residence  was  in  other  States,  and  in  Canada,  several  were 
sojourning  in  this  City  when  attacked  with  the  disorder  for 
the  cure  of  which  they  were  brought  to  the  Asylum. 

The  profession  or  occupation  of  238  men,  is  exhibited  in 
the  subjoined  list.  An  attempt  has  been  made  to  classify 
them  according  to  the  peculiar  nature  of  their  several  em- 
ployments. 


1st.    Mercantile. 

4th.  Mariners. 

Merchants  and  traders. 

Clerks, 

Druggists, 

Manufacturers, 

50 

25 

3 

2 

Naval  officers. 
Sailors, 
Sea  captains 
Pilot, 

2 

11 

3 

1 

2d.  Professional. 

5th.  Exposed  to  Heat. 

Physicians,     . 
Medical  students. 
Lawyers, 
Student  of  Law, 
Artist, 
Architect,  . 

2 
2 
19 
1 
1 
1 

Ironfounder, 

Blacksmiths, 

Engineer, 

Glassblower, 

Bakers, 

Hatter, 

1 
3 
1 
1 
3 
1 

3d.  Dealers   in  Liquor. 

Gth.  Sedentary. 

Tavern  keepers. 

Grocers,* 

Brewer, 

3 
14 
1. 

Sail  maker. 
Shoe  makers, 
Watch  maker, 

1 
2 

1 

'  MoBt  of  them  retailers  of  liquor  by  tho  glass. 


43 


Tailors, 
Saddlec, 
Carpet  weaver 


lih.  Active  employment 
within  doors. 


Brush  maker,     . 

Comb  maker, 

Leather  dressers. 

5 

Carpenter,     . 

Cooper,       .         .  . 

Chair  makers. 

.       2 

Collector  of  taxes, 

Clothier, 

Silkprinter, 

Bookbinder,   . 

Nail  maker. 

Gilder, 

Actor, 

Printer, 

Silversmith, 

Coppersmith, 

Upholsterer,       .        .  1 

Circus  rider,           .        .  1 

Sth.  Active  employment 
out  of  doors. 

Farmers,             .         .  8 

Laborers,       ...  6 

Cartmen,    ...  3 

Pavior,           ...  1 

Painters,    ...  2 

Masons,          ...  4 

Butchers,   ...  9 

Pedlars,          ...  2 

Cider  maker,      .         .  1 

Stage  driver,          .         .  1 

Soldier,       ...  1 

Musician,       ...  1 

lOth.  No  Occupation. 

Men  of  leisure  and  young 
men  without  employ- 
ment, .         .         .23 


Merchants,  traders,  clerks,  professional  men,  persons  of 
leisure  and  young  men  without  employment,  furnish  one 
hundred  and  twenty-nine,  or  ten  more  than  one  half  of  the 
two  hundred  and  thirty-eight  patients  here  recorded.  With- 
out explanation,  the  necessary  inference  must  be  far  from 
flattering  to  these  classes.  It  should  be  recollected,  however, 
that  they  constitute  no  unimportant  proportion  of  the  popu- 
lation of  the  commercial  and  wealthy  city  of  New- York. 
They  are,  moreover,  those  classes  the  members  of  which, 
more  generally  than  those  of  other  portions  of  the  popula- 
tion, resort  to  this  institution  when  thus  diseased.  The  great 
majority  of  persons  whose  pecuniary  resources  are  limited, 
are  taken  to  places  where  the  expenses  are  less.  |' 


44 


Table  showing  the  Age  of  two  hundred  and  ffty-four  Patients. 


Sex. 

Under 
20  years. 

From 
20  to  30 

From 
30  to  40 

From 
40  to  50 

From 
50  to  CO 

From 
60  to  70 

Total. 

Males 

Females... 

3 
0 

77 

8 

81 
19 

36 

7 

10 
6 

5 
2 

212 
42 

Total 

3     1     85 

100 

43 

16 

7 

254 

The  decennium  in  which  there  was  the  greatest  number, 
is  that  from  thirty  to  forty  years.  The  next  is  that  from 
twenty  to  thirty  ;  and  the  third,  that  from  forty  to  fifty. 

In  the  community  at  large,  there  is  a  much  greater  num- 
ber of  persons  between  twenty  and  thirty  years  of  age,  than 
in  any  decennium  of  more  advanced  life.  Hence  the  pro- 
portionate number  of  these  patients  between  thirty  and  forty 
years,  as  compared  with  the  living  population  of  the  corres- 
ponding age,  is  much  greater  than  that  in  any  other  period 
of  existence. 


Table  showing  the  Civil  Condition  of  two  hundred  and  eighty-six  Patients. 


Single, 

Married, 

Widowed, 


Males. 

Females. 

Total 

122 

1 

123 

115 

37 

152 

4 

7 

11 

Total, 


241 


45 


286 


The  number  of  unmarried  men  exceeds  that  of  the  mar* 
ried  by  seven,  although,  if  the  widowed  be  included  with  the 
latter  division,  the  single  predominate  over  the  married,  by 
but  three.  This  approximation  to  equality  of  numbers  in 
the  classes  of  celibacy  and  matrimony,  though  so  strikingly 
remarkable  with  the  men,  does  not  obtain  with  the  women* 
Of  the  latter  sex,  the  married  exceed  the  unmarried  in  the 
proportion  of  thirty-seven  to  one,  or,  if  the  widowed  be  inclu- 
ded with  the  married,  in  the  proportion  of  forty-four  to  one- 


45 


Table  exhibiting  the  Results  of  all  the  Cases  of  Firtt  Admission. 


Besult. 

Cured,     . 

Males. 

244 

Females. 

42 

Total 

286 

Much  improved, 

Improved, 

Relieved, 

1 
0 
1 

0 
3 
0 

1 
3 
1 

Unimproved, 

Eloped, 

Died, 

,       5 
2 

.     19 

2 
0 
1 

7 
2 

20 

Remain, 

2 

0 

2 

Total, 

274 

48 

322 

As  a  general  rule.  Delirium  tremens  soon  terminates  either 
in  recovery  or  death. 

Considering  the  severity  of  the  disease,  it  is  eminently  cu- 
rable. Thus,  of  322  patients,  286  w^ere  cured,  and  but  20 
died.     The  two  still  remaining  in  the  house  are  also  cured. 

It  is  proper  to  remark,  as  has  already  been  intimated,  that 
in  some  of  these  cases,  the  patient  had  no  delirium  while  at 
the  Asylum.  Among  them  were  a  few  in  each  of  the  vari- 
ous conditions  and  phases,  both  temporary  and  more  pro- 
longed, of  intoxication. 

The  rapidity  with  which  the  delirium  approaches  its  cri- 
sis, in  fatal  cases,  is  well  illustrated  by  the  following  table, 
indicating  the  term  of  residence  at  the  Asylum,  of  each  pa- 
tient who  died. 


Time  in  the  Asylum. 

Males. 

Females. 

Total. 

One  day, 

2 

0 

2 

Two  days. 

.     2 

1 

3 

Three  days. 

2 

0 

2 

Four  days. 

.     5 

0 

5 

Five  days, 

1 

0 

• 

Seven  days,     . 

0 

Nine  days,  . 

1 

0 

Ten  days, 

0 

Twelve  days. 

J         •          * 

0 

Thirteen  days, 

0 

Twenty-seven 

days,     .         1 

0 

One  month  and  22  days,       1 

0 

Total, 

.     19 

1 

20 

46 

In  twelve  of  these  twenty  cases,  the  patient  died  within 
four  days  from  the  time  of  his  reception  into  the  Asylum  ; 
and  all  of  them,  excepting  one,  within  twenty-seven  days. 
The  man  who  remained  one  month  and  twenty-two  days, 
died  of  congestive  fever. 

The  death  of  the  man  who  died  on  the  ninth  day,  was  the 
result  of  an  attempt  at  suicide,  by  cutting  his  throat,  before 
admission.  This  was  also  the  case  with  one  of  the  men  who 
died  on  the  fourth  day.  One  of  the  men  committed  suicide 
while  in  the  Asylum. 

SECTION    III. 
OF     R  E- A  D  MISSIONS. 

\st.  Of  Second   Admissions. 

Of  the  three  hundred  and  twenty-two  persons  before-men- 
ioned,  eighty-five  males   and  seventeen   females,  a  total  of 
one  hundred  and  two,  were  admitted  a  second  time,  and  dis- 
charged as  follows : — 


Males. 

Females. 

Total. 

Cured, 

.       74 

15 

89 

Much  improved. 
Improved,     . 
Unimproved,     . 
Eloped, 
Died, 

1 

.       2 
3 

.     2 
1 

0 
0 
2 

0 
0 

1 
2 
5 
2 

1 

By  habeas  corpus, 

Not  stated,          i 

.     1 
1 

0 
0 

1 
1 

*     Total,  ...         85  17  102 

2nd.  Of  Third  Admissions. 

Forty-two  males  and  seven  females,  making  an  aggregate 
of  forty-nine,  were  each  admitted  a  third  time.  They  were 
discharged  as  follows : 


47 


Cured,     . 

Males. 

36 

Female*. 

6 

Total 

42 

Improved,  . 
Unimproved,  . 
Eloped, 
Died,       . 

.       3 
1 

.        1 
1 

1 
0 
0 
0 

4 

1 
1 
1 

ales. 

Femalet. 

Total. 

1 

4 

25 

1 

0 

1 

3 

0 

3 

3 

0 

3 

1 

0 

I 

Total,  ...     42  7  49 

3d.  Of  Fourth  Admissions. 
Of  the  fourth  admissions,  there  were  thirty-three,  of  w^hom 
twenty-nine   were   males   and  four  females.     They  left  the 
Asylum  as  follows : 

Male 

Cured,     .         .         .     "    , 

Improved,  . 

Unimproved,  . 

Eloped, 

Died,       .... 

Total,  .         .       29  4  33 

4th.  Of  Ffth  Admissions. 
Twenty-three  were  received  a  fifth  time  each.     Of  these, 
twenty  were  males  and  three  females.     Discharged  as  fol- 
lows: 

Cured,     .... 

Unimproved, 

Eloped,  .... 

Died,    .         .        .      \ 

Total,       .         .         20  3  23 

hth.  Of  Sixth  Admissions. 
The  sixth  admissions   consist  of  fourteen  males  and  two 
females  :  total,  sixteen.     Of  these,  there  were  discharged 

Cured,     .... 
Unimproved, 

Total,  ...     14  2  16 


Males. 

Females. 

Total 

16 

3 

19 

2 

0 

2 

1 

0 

1 

1 

0 

1 

Males. 

12 

Females. 

2 

Total 

14 

2 

0 

2 

6th.  Of  Seventh  Admissions. 
Eight  males  and  two  females  were  each  admitted  a  seventh 
time.     The  results  in  these  cases  were  as  follows  : 

Males.  Females  Total. 

Cured,     ....  6  1  7 

Unimproved,      ...  1  0  1 

Died,      ....  0  1  1 

Remains,    ....  1  0  1 

Total,       .         .  8  2  10 

Ith.  Of  Admissions  subsequent  to  the  Seventh. 
No  females  were  received  more  than  seven  times.     The 
admissions  of  a  higher  number  were  exclusively  of  males. 
A  succinct  account  of  them  is  contained  in  the  following 
schedule ; 


5  were  received     8  times  each 

5  were  received    9  times  each 

6  were  received  10  times  each 
5  were  received  11  times  each 
3  were  received  12  times  each 
2  were  received  13  times  each 
2  were  received  14  times  each 


and  discharged,  4  cured,  1  improved. 

and  discharged,  4  cured,  1  eloped. 

and  discharged,  4  cured,  1  improved. 

and  discharged,  5  cured. 

and  discharged,  3  cured. 

and  discharged,  2  cured. 

and  discharged,  1  cured,  1  improved. 

One  man  was  received  twelve  times  more,  and  discharged 
cured  seven  times,  relieved  five  times.  His  last  discharge 
was  about  twelve  years  since,  and  during  the  interval  be- 
tween that  time  and  the  present,  his  habits  have  been  strictly 
temperate,  and  his  mental  condition  perfectly  healthy. 

Of  all  diseases  to  which  the  human  race  is  subject,  there  is 
none  that  more  completely  unmans  its  unfortunate  victim, 
more  entirely  divests  him  of  all  the  attributes  the  possession 
of  which  has  justified  him  in  assuming  the  title  of  "  the  lord 
of  creation,"  than  delirium  tremens  when  in  the  plenitude 
of  its  activity. 

The  quivering  tongue,  the  disordered  stomach,  the  torpid 


49 

liver,  the  rapid  pulse,  the  contracted  pupil,  the  inability  to 
sleep,  the  irregularity  of  nervous  power,  the  impotent  func- 
tions of  the  brain  and  the  consequent  insubordination  of  the 
system  to  its  control — these  physical  symptoms,  though  much, 
are  but  little  when  compared  with  the  mental  phenomena 
resulting  from  them.  The  depraved  action  of  the  avenues  to 
the  mind, — the  external  senses — and  the  unhealthy  functions 
of  the  perceptive  faculties,  whence  the  patient  is  unable  to 
appreciate  or  understand  the  nature  or  the  relations  of  the 
objects  by  which  he  is  surrounded,  the  entire  confusion  of  hiis 
ideas  of  matter,  time  and  space,  the  law^s  by  which  they  are 
regulated  and  the  inevitable  results  of  those  laws,  if  not  the 
least  alarming  are  certainly  less  prominent  and  imposing 
than  some  of  the  other  symptoms.  These  may  be  called  the 
negative  mental  phenomena.  The  positive  are  more  salient, 
and  hence  make  a  stronger  impression  upon  the  beholder. 
They  are  the  visions  which  are  continually  conjured  up  by 
a  wayward,  excited,  and  ungovernable  imagination,  more 
varied  in  their  forms  and  characters  than  are  the  designs  of 
the  boldest  artist,  more  diverse  and  unstable  than  the  ever- 
changing  pictures  of  a  phantasmagoria. 

The  walls  of  his  apartment,  mere  mortar  and  whitewash 
to  the  view  of  other  people,  present  to  the  patient  pictures  of 
every  possible  variety  in  character  and  composition.  Ani- 
mals of  various  kinds  throng  into  his  room,  crouch  before 
him  with  threatening  gestures,  and  grimaces  the  most  fright- 
ful, creep  beneath  his  bed,  or  crawl  upon  it  with  torturing 
menaces.  Enemies  in  human  form  spring  up  to  bind,  to  drag 
to  prison,  to  the  tribunal  of  justice,  to  the  rack  or  to  the 
place  of  execution,  or,  perchance  to  shoot  or  to  slay  with  the 
sword  ;  and,  finally,  the  phantoms  of  the  ideal  world,  spectres 
with  gorgon  heads,  and  bodies  more  hideous  than  those  of  the 
satyr  or  the  fabled  tenants  of  the  lower  regions,  glower  upon 
him  with  their  eyes  of  fire,  gnash  their  teeth  in  fiendish  defi- 


60 

ance,  at  length  seize  upon  him,  and  he  struggles  with  them 
in  the  full  faith  that  he  has  encountered  the  devil  incarnate. 

Such  are  the  features  which  constitute  the  most  distinctive, 
and,  to  some,  the  most  appalling  characteristics  of  this  dis- 
ease. How  beautiful  the  results  of  the  harmonious  move- 
ments of  that  system  which,  as  the  crowning  work  of  the 
creation,  was  both  "  fearfully  and  wonderfully  made,"  yet 
how  revolting  the  effects  of  its  discordant  action  ! 

But,  as  has  already  been  observed  and  demonstrated,  not-  ' 
withstanding  the  remarkable  physical  disorder,  and  the  hete- 
rogeneous medley  of  mental  phenomena,  attendant  upon  the 
malady  in  question,  there  are  but  few  acute  diseases  involv- 
ing any  important  organ,  or  series  of  organs,  which  are  more 
curable.  The  physical  powers,  though  so  nearly  prostrate, 
rise  with  a  resiliency  which  is  truly  remarkable,  and  the 
mind  rapidly  resumes  its  healthy  action. 

It  has  already  been  observed  that  Delirium  tremens  is  not 
usually  considered  as  ranking  under  the  general  head  of  In- 
sanity proper.  What  opinion  soever  may  be  entertained 
upon  this  subject,  the  malady  is  so  different  from  ordinary 
mental  alienation,  in  both  its  characteristics  and  its  duration, 
that  the  therapeutic  principles  adapted  to  the  treatment  of 
the  former  are  entirely  inapplicable  to  the  latter.  Hence,  as 
well  as  for  reasons  hereafter  to  be  mentioned,  we  have  ever 
held  the  opinion— and  it  has  been  very  strongly  confirmed 
by  the  practical  observation  of  several  years — that  cases  of 
delirium  tremens  ought  not  to  be  admitted  into  institutions 
intended  for  the  insane. 

The  disease  is  of  short  duration,  and  consequently  the  pa- 
tient requires  absolute  seclusion,  or  close  confinement,  for  but 
a  limited  period.  The  converse  of  this  proposition,  as  a  ge- 
neral rule,  obtains  with  the  insane.  The  internal  police  of  an 
Asylum  cannot  therefore  be  well  adapted  to  the  necessities  of 
the  two  classes.    The  supervision,  the  restraint,  the  abridge- 


51 

merit  of  liberty  necessary  for  the  one,  are  not  so  for  the  other. 
If  the  delirium  patients,  after  recovery  from  the  immediate 
effects  of  the  disease,  be  allowed  to  have  all  the  priviHges  to 
which  they  are  entitled,  compatible  with  their  condition,  ill 
feeling  and  jealousy  are  engendered  among  the  insane,  to 
whom  those  privileges  cannot  safely  be  extended. 

Of  the  many  cases  of  delirium  tremens  which  have  been 
admitted  into  this  institution,  there  have  been  but  compara- 
tively few  instances  of  entire  reform  from  the  habit  of  intox- 
ication. Such  reformation  could  not  be  expected  from  the 
brief  term  of  seclusion  to  which  the  patients  are  subjected. 
Accustomed  as  the  persons  have  been,  in  most  cases,  for 
many  years  to  the  use  of  liquor,  the  whole  frame,  and  parti- 
cularly the  nervous  system — those  organs  so  mysterious  in 
their  organization,  so  wonderful  in  their  functions,  and  so 
difficult  of  control — have  adapted  themselves  to  the  stimulus. 
Every  system  of  organs,  every  organ,  every  fibre,  every 
ultimate  corpuscle  which  assists  in  making  up  the  fabric  of 
the  body,  and  lends  its  agency  in  prosecuting  the  phenomena 
of  vitality,  has,  as  it  were,  obtained  an  abnormal  appetite 
which  calls  loudly  and  perseveringly  for  indulgence, — an 
appetite  which  cannot  be  resisted  but  by  a  strong  effort 
of  the  moral  power.  Hence  the  only  hope  of  reformation, 
in  a  great  majority  of  cases,  lies  in  a  prolonged  seclusion, 
and  a   compulsory  abstinence  from  stimuli. 

It  is  to  be  hoped  that  within  the  State  of  New- York,  where 
the  interests  of  the  insane,  the  deaf  and  dumb  and  the  blind 
are  so  carefully  guarded,  and  where  donations  so  liberal  have 
been  appropriated  for  their  benefit,  an  institution  for  the  in- 
temperate will,  at  no  distant  period,  be  established. 


CHAPTER  11. 

CASBS      OF      INSANITY. 
SECTION    I. 

Of  the  number  of  Patients  Admitted. 

We  now  proceed  to  an  analysis  of  the  cases  of  those  forms 
of  mental  disorder  which  are  universally  recognised  as  pro- 
per to  be  arranged  under  the  generic  term  Insanity. 

It  may  be  stated,  before  commencing  the  investiga- 
tion, that,  in  a  few  instances,  the  patient  whose  disease,  on 
his  first  admission,  was  delirium  tremens,  was  re-admitted 
laboring  under  monomania  or  mania.  These  cases  are  all 
included  in  the  foregoing  chapter.  In  a  similar  manner,  there 
are  a  few  instances,  among  the  cases  now  about  to  come 
under  observation,  in  which  the  patient,  at  the  time  of  his 
first  admission,  was  laboring  under  an  attack  of  one  of  the 
forms  of  insanity,  but  who,  after  having  been  restored  to 
health,  and  discharged  from  the  Asylum,  was,  at  a  subse- 
quent period,  again  received,  his  malady  at  this  time  being 
delirium  tremens.  Were  these  cases  to  be  found  in  but  one 
alone  of  the  two  great  classes  referred  to,  their  numbers  are 
not  sufficient  to  exert  any  important  influence  upon  the  results. 
As  it  is,  they  nearly  counterbalance  each  other,  somewhat 
predominating,  it  is  true,  in  the  former  class,  since  it  is  the 
tendency  of  repeated  attacks  of  delirium  tremens  to  induce 
permanent  insanity,  in  one  of  its  forms. 


53 

The  whole  number  of  patients  admitted,  from  the  16th  of 
June,  1821,  to  the  31st  of  December,  1844,was,  as  has  already 
been  seen  in  the  table  included  in  Part  First,  two  thousand 
nine  hundred  and  thirty-seven  ;  of  whom  one  thousand  eight 
hundred  and  seventy-two  were  males,  and  one  thousand  and 
sixty-five  females.  Deducting  from  these  the  five  hundred 
and  ninety-four  cases  of  delirium  tremens,  already  analjrzed, 
there  remain  two  thousand  three  hundred  and  forty-three 
cases,  of  which  one  thousand  three  hundred  and  sixty-one 
were  males,  and  nine  hundred  and  eighty-two  females.  From 
these,  the  following  cases  should  also  be  subtracted : — 

Males.  Females.        Total, 

Discharged  as  improper  objects,  8  8  16 

In  the  Asylum  from  one  to  four  days,'^ 

dischargedbyrequest  of  their  friends  (      «  k  q 

and  no  history  of  their  cases  re-  C 

corded,  J 

Discharged  on  the  day  of  admission,  0  2  2 

Transferred  from  private  account  to  "^ 

the  charge  of  the  Alms-house,  and  (9  n  2 

the  name  re-entered,  although  the    [ 

patient  was  already  in  the  house,    J 

Absent  a  few  days,  by  elopement  or  ^ 

on  a  visit  to   their    friends,    and   K,     a  n  (t 

their  names  re-entered    on   their    ( 
return,  J 

Boarder,  as  companion  to  a  patient,  Oil 

Total,  17  18  35 

A  deduction  having  been  made  for  these,  there  remain  two 
thousand  three  hundred  and  eight  cases,  of  which  one  thou- 
sand three  hundred  and  forty-four  were  males,  and  nine  hun- 
dred and  sixty-four  females. 

These  cases  include  all  the  admissions,whether  first,  second, 
third  or  any  higher  number,  of  all  the  patients  laboring  under 


54 

insanity.  The  number  of  original  admissions,  as  well  as  the 
subsequent  re-admissions,  are  arranged  in  the  subjoined 
table. 


First  admission, 
Second  admission. 
Third  admission, 
Fourth  admission, 
Fifth  admission, 
Sixth  admission. 
Seventh  admission. 
Eighth  admission. 
Ninth  admission. 
Tenth  admission, 
Eleventh  admission. 
Twelfth  admission, 
Thirteenth  admission. 
Fourteenth  admission. 
Fifteenth  admission, 
Sixteenth  admission, 
Seventeenth  admission, 
Eighteenth  admission. 
Nineteenth  admission. 
Twentieth  admission. 
Twenty-first  admission, 
Twenty-second  admission, 

Total, 


Males. 

Females. 

Total. 

1090 

751 

1841 

168 

112 

280 

46 

35 

81 

22 

11 

33 

11 

7 

18 

2 

6 

8 

2 

5 

7 

1 

3 

4 

1 

3 

4 

1 

3 

4 

0 

3 

3 

0 

3 

3 

0 

3 

3 

0 

3 

3 

0 

3 

3 

0 

2 

2 

0 

2 

2 

0 

2 

2 

0 

2 

2 

0 

2 

2 

0 

2 

2 

0 

1 

1 

1344        964       2308 


Thus,  although  the  whole  number  of  cases  was  two  thoU' 
sand  three  hlindred  and  eighty  it  appears,  by  the  first  admis- 
sions, that  the  actual  number  of  persons,  was  but  one  thousand 
eight  hundred  and  forty-one,  of  whom  there  were  one  thou- 
sand and  ninety  males,  and  seven  hundred  and  fifty-one 
females.  To  these  persons  alone,  and  to  their  disease  on 
their  first  reception  into  the  Asylum,  our  attention  will  be 
first  directed. 


65 


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56 

The  greatest  annual  number  of  first  admissions  was  in 
1821,  This  predominance  is  sufficiently  accounted  for 
by  the  fact  that  fifty-two  patients  were  transferred  from 
the  Asylum  in  the  city.  The  next  highest  number  was 
in  1833,  when  there  were  one  hundred.  Of  the  third  in  rank, 
there  are  three  years,  1830,  1831  and  183G,  in  each  of  which 
the  number  was  ninety-two. 

It  is  worthy  of  remark  that,  during  the  first  eleven  years, 
from  1822  to  1832,  both  inclusive,  the  aggregate  number  of 
admissions  was  eight  hundred  and  sixteen,  while,  during  the 
similar  period  from  1834  to  1844,  the  number  was  eight 
hundred  and  twenty-three.  From  the  rapid  increase  of  the 
neighboring  population,  as  well  as  from  the  greater  willing- 
ness of  the  friends  of  the  insane  to  place  them  in  public  in- 
stitutions, one  might  reasonably  infer  that  the  number  of  first 
admissions,  during  the  latter  period,  would  greatly  predomi- 
nate over  that  of  the  former.  The  excess,  however,  is  but 
seven.  The  foundation  of  other  institutions,  as  already  al- 
luded to,  was  a  cause  sufficiently  preventive  of  any  consider- 
able augmentation  of  numbers  in  this  establishment. 

It  is  a  point  of  some  interest  to  ascertain  the  particular 
months  in  which  the  greatest  numbers  were  brought  to  the 
Asylum.  In  order  to  arrive,  as  nearly  as  possible,  to  an  ac- 
curate result  on  this  point,  it  is  necessary  to  reject  the  ad- 
missions in  1821,  inasmuch  as  the  institution  was  not  opened 
until  the  middle  of  June.  This  done,  there  remains  a  period 
of  twenty- three  complete  years.  To  avoid  another  cause  of 
error,  deduction  must  also  be  made  of  the  patients  who  were 
brought,  en  masse,  from  the  Alms-house,  the  numbers  and 
time  of  admission  of  which  have  already  been  detailed  in 
Part  First.  It  is  obvious  that  patients  brought  in  this  man- 
ner do  not  fairly  represent  the  ordinary  current  of  admissions. 


57 

In  several  instances,  the  cases  coming  from  the  Alms-house 
were  re-admissions.  The  whole  number  of  first  admissions 
was  as  follows : 

In  January",  1824,  there     were  8 

In  August,  1831,               „  17 

In  September,  1831,               „  7 

In  July,  1833,               „  24 

In  January,  1835,              „  10 

Making  the  whole  number       G6 

These  being  subtracted,  the  monthly  admissions,  for  the 
twenty- three  years,  were  for 


January, 

77 

July, 

157 

February, 

90 

August, 

151 

March, 

126 

September, 

138 

April, 

144 

October, 

148 

May, 

186 

November, 

134 

June, 

202 

December, 

120 

The  minimum  number  is  in  January,  and  thencefjrward 
there  is  a  regular  increase  until  June,  in  which  is  the  maxi- 
mum ;  and  thereafter  a  progressive  diminution,  with  the  single 
exception  of  November,  throughout  the  remaining  months. 

Various  authors  who  have  written  upon  mental  diseases, 
as  well  as  other  physicians  who  have  devoted  much  time  to 
the  treatment  of  them,  have  endeavored  to  ascertain  the 
extent  of  the  influence  exerted  by  the  different  seasons  of  the 
year,  as  a  generative  or  exciting  cause  of  insanity.  It  is  rea- 
sonable to  suppose  that,  other  things  being  equal,  the  change 
of  temperature  from  winter  to  spring,  and  the  heat  of  the 
warmer  months  of  the  year,  acting,  as  they  do,  as  causes  of 
debility  in  the  human  frame,  and,  the  latter  particularly,  in- 
ducing a  greater  indulgence  in  beverages  of  a  deleterious 
nature,  as  well  as  congestion  of  the  liver  and  some  other  phy- 
sical disorders,  should  operate  as  productive  causes  of  mental 
alienation. 

4 


58 

For  the  purpose  of  accurately  illustrating  this  subject  by 
the  cases  before  us,  they  are  here  arranged  according  to  the 
.several  seasons. 

Spring.  Summer.  Autumn.  Winter. 

March,  126  June,         202  September,  138     December,  120 
April,      144  July,  157  October,         148     January,        77 

May,       186  August,     151   November,    134     February,      90 


Total,  456        Total,  510  Total,  420  Total,  287 

It  will  be  perceived  that  the  greatest  number  was  in  Sum- 
mer, the  next  in  Spring,  the  third  in  Autumn,  and  the  least 
in  Winter. 

By  assembling  in  one  class,  the  six  months  from  April  to 
September  inclusive,  that  half  of  the  year  in  which  the  tem- 
perature exercises  its  greatest  influence,  and  in  another  class, 
the  six  months  from  September  to  March,  when  that  influ- 
ence is  least,  the  contrast  is  rendered  still  more  apparent. 
The  number  in  the  former  period  is  nine  hundred  and  seventy- 
(3ight,  and  in  the  latter,  six  hundred  and  ninety-five.  This 
shows  an  excess  of  forty  per  cent  in  the  season  of  the  highest 
temperature. 

Since,  in  a  large  majority  of  cases,  some  time  elapses  after 
(he  first  invasion  of  insanity  before  the  patient  is  removed  ta 
the  Asylum,  it  is  obvious  that  the  month,  or  season  of  admis- 
sion does  not  always  correspond  with  that  of  the  commence- 
ment of  the  disease,  which  is  the  period  desirable  to  be  ob- 
tained. Again,  the  more  favorable  weather  and  the  greater 
facilities  for  traveling,  during  (lie  warmer  months,  are  in- 
ducements to  people  residing  at  a  great  distance  to  select 
tlfat  season  for  bringing  patients.  In  regard  to  this  Institution, 
however,  no  inconsiderable  portion  of  the  cases  were  of  but 
short  duration,  and  a  very  large  majority  of  them  lived  in 
such  near  proximity  to  the  Asylum  as  to  render  access  to  it 
at  all  times  easy.  This  table,  therefore,  assumed  as  a  criterion 


59 

of  the  general  prevalence  or  occurrence  of  insanity,  would 
not  be  so  inaccurate  as  under  other  circumstances  it  might 
have  been.  It  undoubtedly  is  somewhat  modified  by  the  in- 
fluences mentioned. 


SECTION    III. 
SEX. 


The  number  of  persons  of  either  sex,  arranged  according 
to  the  admissions  during  each  year,  may  be  seen  in  the  fol- 
lowing table : — 


Year. 

Males. 

Females. 

Total. 

Year. 

Males. 

Females. 

Total. 

1821 

56 

46 

102 

Bro't  up, 

612 

403 

1018 

1822 

27 

26 

53 

1834 

49 

31 

80 

1823 

43 

31 

74 

1835 

46 

40 

86 

1824 

33 

31 

64 

1836 

49 

43 

92 

1825 

47 

33 

80 

1837 

42 

27 

69 

1826 

52 

29 

81 

1838 

56 

27 

83 

1827 

56 

18 

74 

1839 

43 

32 

75 

1828 

45 

36 

81 

1840 

48 

32 

80 

1829 

34 

21 

55 

1841 

39 

32 

71 

1830 

64 

28 

92 

1842 

40 

21 

61 

1831 

54 

38 

92 

1843 

27 

27 

54 

1832 
1833 

43 

58 

27 
42 

70 

100 

1844 

39 

33 

72 

Total, 

1090 

751 

1841 

Car'd  up, 

612 

406 

1018 

Hence  it  appears  that  the  number  of  males  exceeded  that 
of  females,  in  the  ratio  of  1,090  to  751,  or  of  145  to  100. 

Aretseus,  who  lived  in  the  first  century  of  the  Christian 
era,  suggested  the  opinion  that  mental  alienation  is  more 
frequent  a,mong  men  than  among  women ;  and  his  belief  was 
sustained  byCoelius  Aurelianus,  in  the  second  century.  The 
idea  was  handed  down,  from  age  to  age,  and  its  correctness 
appears  not  to  have  been  questioned  for  nearly  eighteen  hun- 
dred years.  About  the  commencement  of  the  present  century, 
the  eminent  French  physician  and  author,  Pinel,  advanced  the 


60 

opposite  opinion ;  and  soon  afterwards  his  successor,  Esqui- 
rol,  having  thrown  additional  light  upon  the  subject  by  the 
collection  of  statistics  from  nearly  all  the  departments  of 
France,  and  from  various  other  parts  of  Europe,  also  con- 
cluded that  females  are  more  subject  to  the  disease  than 
males. 

Nearly  all  European  authors  whose  works  have  appeared 
since  that  of  Esquirol,  apparently  assuming  his  authority  as 
infallible,  have  adopted  his  conclusion  without  investigating 
the  subject  to  any  material  extent  themselves.  Perhaps 
farther  experience  and  more  accurate  research  will  demon- 
strate this  opinion  to  be  erroneous  ;  but,  however  this  may  be 
in  regard  to  Europe,  it  seems  sufficiently  evident  that  the  be- 
lief of  Areta3us  is  correct,  so  far  as  it  relates  to  the  United 
States  of  America.  The  foregoing  statistics  confirm  it;  the 
number  of  men  being  forty-five  per  cent  more  than  that  of 
women,  and  the  results  at  other  institutions  are  similar  to 
these. 

Hitherto,  however,  at  least  until  within  a  very  few  years, 
there  has  been  an  apparently  greater  unwillingness  to  re- 
move females,  than  males,  to  the  public  institutions.  This 
may,  to  some  extent,  account  for  the  disparity  of  numbers. 
In  the  first  series  of  twelve  years  included  in  the  foregoing 
table,  the  men  exceed  the  women  by  fifty-two  per  cent ; 
while,  in  the  last  series  of  the  same  number  of  years,  the 
corresponding  excess  is  but  thirty-eight  per  cent.  Making 
all  due  allowance  for  this,  and  for  any  other  fact  or  circum- 
stance which  may  operate  in  a  similar  manner,  we  still  believe 
that  the  number  of  insane  men  in  this  country  does,  and  will, 
for  a  long  time  to  come,  greatly  predominate  over  that  of 
insane  women.  The  origin  of  this  predominance  undoubted- 
ly lies  in  the  causes  productive  of  the  disease. 

On  the  supposition  that  the  cases  brought  to  this  Asylum 


61 

accurately  represent  the  comparative  number  of  the  insane 
of  the  two  sexes  amongst  our  population,  still  it  does  not  ne- 
cessarily follow  that  they  indicate  the  proportion  of  the  sex- 
es who  become  insane ;  or,  in  other  words,  the  comparative 
liability  of  the  sexes  to  mental  disorder.  They  would  do  this 
if  the  number  of  males  and  females  in  the  general  popula- 
tion were  equal.  This,  however,  does  not  obtain.  Even  if 
it  were  a  physiological  law,  applicable  to  the  whole  race  of 
man,  that  the  two  sexes  should  correspond  in  numbers,  there 
are  many  causes  which  destroy  the  balance  in  particular 
communities,  giving  in  one  an  excess  of  males,  and  in 
another  of  females. 

According  to   the  National   Census   of  1840,   the   white 
population  of  the  State  of  New- York  was. 

Males,  ....     1,207,357 

Females,        ....     1,171,533 


Total,  .  .     2,378,890 

The  number  of  males  exceeded  that  of  females  by  35,824. 
In  the  Southern  District  of  the  State  there  were 

Males,  ....     353,428 

Females,  ....     355,257 


Total,  .  .     708,685 

Here  the  number  of  females  was  1,829  greater  than  that 
of  the  males.  This  district  includes  the  city  and  county  of 
New-York,  in  which  the  population  was  as  follows  : 

Males,  ....     142,731 

Females,         ....     153,621 


Total,  .  .     296,352 

Now,  by  comparing  the  patients  brought  to  the  Asylum 
with  the  whole  population,  according  to  sex,  1st.  of  the  City 
and  County,  2nd.  of  the  Southern  District,  and  3rd.  of  the 
State,  we  find  that 


62 


Insane  Insane 

Females  Males. 


In  the  City  and  County,  for  each     100  ,  there  would  be     163 
In  the  Southern  District,     do,       100  do.  146 

In  the  State,      .  .         do.       100  do.  141 

As  insanity  is  extremely  rare  in  persons  under  fifteen  years 
of  age,  it  is  not  strictly  correct,  in  a  calculation  like  the  fore- 
going, to  include  the  whole  population.  By  taking,  therefore, 
the  population  over  fifteen  years  of  age,  the  results  are  as 
follows : 

Insane  Insane 

Females  Males. 

In  the  City  and  County,  for  each     100     there  would  be     157 
In  the  Southern  District,     do.       100  do.  146 

In  the  State,  ,         .       do.       100  do.  141 

The  results  correspond  with  those  before  obtained,  except- 
ing in  the  city  and  county,  in  which  the  proportionate  num« 
ber  of  males  is  diminished  by  five. 


63 


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In  a  nation  composed  of  so  heterogeneous  a  population  as 
that  of  the  United  States — a  country  which  is  the  focus 
towards  which  the  streams  of  emigration  concentrate — it  is 
to  be  expected  that  many  of  the  inmates  of  its  public  insti- 
tutions will  be  foreigners.  Thus,  there  were  natives  of 
nearly  all  the  European  States  among  the  patients  of  the 
Asylum. 

Of  1712  whose  nativity  was  recorded,  only  1271  were 
born  in  the  United  States;  while  441  were  imigrants  from 
other  countries.  Of  the  latter,  the  greatest  number  were 
from  Ireland,  the  next  from  Engl  and,  the  third  from  Scotland, 
the  fourth  from  France,  and  the  fifth  from  Germany.  These 
are  nearly  in  proportion  to  the  population  of  the  people  of 
those  countries,  resident  in  the  United  States.  It  would  ap- 
pear, however,  that  the  proportionate  number  of  Scotch  is 
greater  than  that  of  either  French  or  Germans.  The  propor- 
tion of  French  also  apparently  exceeds  that  of  the  Germans. 


Table  showing  the  Residence  of  the  Patients. 

State. 

M. 

F. 

Total. 

State  or  Country. 

M. 

F. 

Total. 

New-York, 

New  Jersey,  — 
Connecticut,.  . . 
Pennsylvania, . . 
Massachusetts  . 
South  Carolina, 
Ohio, 

852 
87 
25 
10 
5 
6 
4 
4 
5 
3 
4 
] 
2 
3 
1 
1 
1 

598 
56 
4 
9 
4 
2 
2 
2 
0 
2 
0 

1 
0 
2 
2 

1 

1450 
143 
29 
19 
9 
8 
6 
6 
5 
5 
4 
3 
3 
3 
3 
3 
2 

Brought  up,  . 

Virginia, 

Tennessee, . 

Illinois, 

Total  U.  S... 

Canada,    

West  Indies, . . . 
Nova  Scotia,. .. 

Brazil, 

England, 

Ireland, 

Bermuda 

Cape  of  G.Hope 

Scotland, 

Unknown, 

Total, 

1014 

1 
1 
0 

1016 

11 

IC 

2 

1 
2 
2 
2 

1 

1 

42 

687 
0 
0 

1 

688 

7 
4 
1 
0 
1 
0 
0 
0 
0 
50 

1701 
1 
1 
1 

1704 

18 
14 
3 
1 
3 
2 
2 
1 
1 
92 

Louisiana, 

North  Carolina, 

Georgia, 

Vermont, 

Rhode  Island,. . 

Michigan, 

Dist.  Columbia, 

Marylatid, 

Alabama, 

Florida, 

Carried  up  .. 

1014 

687 

1701 

1090 

751 

1841 

65 

Of  one  thousand  seven  hundred  and  forty-nine  patients,  the 
places  of  whose  residence  is  recorded,  one  thousand  four  hun- 
dred and  fifty  were  from  the  State  of  New- York.  The  re- 
mainder were  from  eighteen  of  the  other  States,  the  District 
of  Columbia,  and  nine  foreign  countries  ;  the  majority  being 
from  the  adjacent  States  of  New  Jersey  and  Connecticut. 

SECTION    V. 
AGE. 

The  age  of  but  one  thousand  seven  hundred  and  ten  pa- 
tients was  ascertained.  These  are  arranged  in  the  following 
table : — 

Under  twenty  years. 
From  twenty  to  thirty  years, 
From  thirty  to  forty  years,     . 
From  forty  to  fifty  years, 
From  fifty  to  sixty  y^ars. 
From  sixty  to  seventy  years. 
From  seventy  to  eighty  years, 
From  eighty  to  ninety  years. 


Males. 

Females. 

Total. 

65 

51 

116 

359 

268 

627 

292 

171 

463 

157 

113 

270 

87 

66 

153 

37 

19 

56 

17 

5 

23 

1 

2 

3 

Total  .  .  1015  695         1710 

The  number  in  the  decennium  from  twenty  to  thirty  years 
is  much  larger  than  that  in  any  other  similar  period,  and  ex- 
ceeds that  of  the  next  highest  decennium,  which  is  that  from 
thirty  to  forty  years,  by  thirty-five  per  cent.  The  §everal 
periods — whether  reference  be  had  to  the  total  numbers,  or 
to  those  of  either  sex  separately — if  arranged  according  to 
the  numbers  in  each,  beginning  with  the  highest  and  regu- 
larly descending,  are  as  follows : —  ' 


1st.    from  twenty  to  thirty  years. 
2d.    from  thirty  to  forty         " 
3d.    from  forty  to  fifty  " 

4th.  from  fifty  to  sixty  '' 


5th.  under  twenty  years. 
6th.  from  sixty  to  seventy  years. 
7th.  from  seventy  to  eighty   " 
8th.  from  eighty  to  ninety      " 


Omitting  the  cases  under  twenty  years,  there  is  a  regular- 
ly progressive  diminution,  throughout  the  several  decades  in- 
cluded in  the  table. 


66 

Assuming,  therefore,  these  data  as  the  exponent  of  the 
whole  insane  population  of  the  country,  it  is  evident  that 
mental  diseases  are  far  more  prevalent  in  the  period  from 
twenty  to  thirty  years  of  age,  than  in  any  other  epoch  of 
equal  duration  in  human  life. 

The  comparative  proportion  in  the  different  periods  may> 
perhaps,  be  more  fully  appreciated,  by  a  calculation  of  the 
following  description : — 

Supposing  the  number  between  20  and  30  to  be  represented  by  100 
Then  the  number  between  30  and  40  will  be  represented  by  73/^ 


<l                     II 

l( 

40 

11 

50 

(1 

I             <( 

43 

«                         << 

l< 

50 

<i 

60 

(              II 

24tV 

i(                       II 

under 

20 

1              <i 

18tV 

((                         << 

between 

60 

<( 

70 

(1                 a 

8tV 

«                         <l 

1. 

70 

<( 

80 

<                 II 

3^ 

«                     l( 

K 

80 

ii 

90 

(                ii 

47 

1  o>«  07 

Some  writers  have  averred  that,  inasmuch  as  the  constitu- 
tional revolution  popularly  known  as  "the  change  of 
life,"  in  females,  is  a  prolific  cause  of  mental  disorder,  and 
as  this  occurs,  generally,  between  the  fortieth  and  the  fiftieth 
year,  that,  therefore,  the  average  age  at  which  women  be- 
come insane,  is  higher  than  that  of  men.  It  will  be  perceived, 
however,  that  the  above  table  of  ages  furnishes  no  proof  of  this 
proposition.  The  numbers  of  the  females  follow  the  same 
gradation,  and  in  nearly  the  same  proportion  as  those  of  the 
males. 

Although  by  far  the  greater  number  of  the  patients  were 
between  the  ages  of  twenty  and  thirty,  yet  it  must  not  be 
inferred  that  the  greatest  liability  to  insanity  is  during  that 
period,  for,  in  the  general  population  of  the  country,  the 
adults  in  that  decennium  far  out-number  those  of  any  other. 
By  comparing  the  number  of  patients  in  each  department 
of  the  foregoing  table,  with  the  number  of  the  correspond- 


.        67 

ing  age  in  the  population  of  the  State  of  New- York,  the 
proportion  of  insane  between  thirty  and  forty  years  of  age  is 
found  to  be  greater  than  that  in  any  other  decennium. 

The  number  of  persons  in  the  general  population,  who, 
between  the  ages  of  thirty  and  forty  years,  furnish  100  in- 
sane, would, 

If  between  the  ages  of  40  and  50  years,  furnish  but  94  insane 


50  "  60  " 

((    it 

92 

20  "  30  " 

a            a 

89 

60  "  70  •* 

«     a 

60 

70  '•  80  *' 

«     (( 

49 

under   20  " 

<(     (> 

28 

80  and  90  " 

((     « 

24 

It  would  be  desirable  to  exhibit  the  age  of  the  patients  at 
the  time  of  the  first  invasion  of  the  disease,  but  the  records 
upon  this  point  are  not  sufficiently  perfect  to  render  such  an 
exposition  entirely  practicable.  In  a  large  proportion  of  the 
cases,  it  is  evident  that  the  time  between  the  first  attack  and 
the  period  of  admission  would  not  be  sufficient  to  make  any 
alteration  in  the  table,  by  removing  them  from  one  decenni- 
um to  another.  But  in  the  remainder  the  reverse  would  be 
true.  In  several  hundreds  of  cases  the  time  of  first  attack  is 
stated,  and  in  two  hundred  and  sixty  of  them  that  time  was 
in  an  earlier  decennium  of  life  than  that  in  which  the  patient 
was  admitted.  By  re-arranging  these  two  hundred  and 
sixty  cases,  so  as  to  introduce  the  time  of  first  attack,  the  table 
will  stand  as  follows  : 


Under  twenty  years,     .         .         .  .         190 

Between  twenty  and  thirty  years,  .         .     651 

Between  thirty  and  forty  years,    .  .         441 

Between  forty  and  fifty  years,  .         .     240 

Between  fifty  and  sixty  years,      .  .         119 

Between  sixty  and  seventy  years,  .         .       53 

Between  seventy  and  eighty  years,  .           14 

Between  eighty  and  ninety  years,  .         .         2 


68 

By  this  process,  the  number  in  the  period  from  twenty  to 
thirty  years  is  considerably  increased,  while  those  in  the 
higher  decades  are  all  diminished. 

Again,  the  number  under  twenty  has  received  so  import- 
ant an  accession  that  it  ranks  in  the  fourth  place,  instead  of 
the  fifth. 

The  number  between  twenty  and  thirty  is  now  more  than 
sixty-seven  per  cent  greater  than  that  between  thirty  and 
forty. 

This  table  may  be  considered  a  comparatively  near  ap- 
proximation to  the  time  of  first  attack,  and  comparing  it  with 
the  population,  as  was  done  before,  the  following  results  are 
obtained. 

The  greatest  proportion  of  insane,  relative  to  the  population, 
is  between  the  ages  of  thirty  and  forty  years  ;  and  the  num- 
ber of  persons  who,  in  that  decade,  furnish  one  hundred  in- 
sane, would, 

If  between  the  ages  of  20  and  30  years,  furnish  but  97 

„                 „  40  and  50  „  •    88 

„                  „  50  and  60  „  75 

„  60  and  70  „  59 

„         under  20  „  48 

„         between  70  and  80  „  37 

„                 „  80  and  90  „  17 

According  to  these  data,  then,  the  liability  to  mental  de- 
rangement is  greatest  between  the  ages  of  thirty  and  forty 
years,  although  it  is  nearly  as  great  between  twenty  and  thirty ; 
and  in  the  more  advanced  stages  of  life  that  liability  rapidly 
diminishes. 

It  is  highly  probable  that,  if,  in  all  cases,  the  date  of  first 
invasion  of  the  disease  could  have  been  obtained,  the  liabili- 
ty would  have  been  shown  to  be  at  its  maximum  in  the  de- 
cennium  from  twenty  to  thirty  years. 


69 

SECTION  VI. 
CIVIL      CONDITION. 

The  influence  which  position  in  life,  in  regard  to  celibacy 
and  marriage,  exerts  as  a  cause  of  mental  disease,  became, 
long  since,  a  subject  of  inquiry.  So  far  as  this  position  was 
ascertained,  relative  to  the  patients  at  this  institution,  the  re- 
sults are  as  follows  : — 


Males. 

Females. 

Total. 

Single, 

570 

273 

843 

Married, 

432 

358 

790 

Widowed, 

36 

80 

116 

Total,         1038         711        1749 

Of  seventeen  hundred  and  forty-nine  patients,  eight  hun- 
dred and  forty-three  had  never  been  married.  Seven  hundred 
and  ninety  were  married,  and  their  partners  living  ;  and  one 
hundred  and  sixteen  were  widowed.  Thus,  the  single  exceed 
the  married,  exclusive  of  the  widowed;  but  if  the  latter  be 
included,  the  married  exceed  the  single. 

In  men,  the  number  of  the  single  is  greater  than  that  of 
both  the  married  and  widowed,  by  one  hundred  and  two,  which 
is  equivalent  to  eighteen  per  cent.  On  the  contrary,  with  the 
women,  the  married  whose  husbands  were  living,  far  exceed- 
ed the  single,  and  including  the  widows,  that  excess  is  one 
hundred  and  sixty-five  or  a  little  over  sixty  per  cent. 

This  difference  in  regard  to  the  sexes  is,  to  us,  both  remark- 
able and  unexpected.  The  fact  that  among  the  insane  ad- 
mitted into  this  establishment,  the  number  of  unmarried  men 
should  predominate  so  much  over  the  married,  while,  with 
the  women,  the  reverse,  to  a  very  remarkable  extent,  should 
obtain;  can  only  be  accounted  for  in  the  supposition  that,  in 
the  community  whence  these  persons  mostly  came,  there  are 
peculiar  influences  operating  upon  the  public  health. 


70 

In  regard  to  females,  there  are  special  causes  which  may, 
at  all  times  and  in  all  comitries,  render  the  number  of  mar- 
ried greater  than  of  single  among  the  insane, — although  we 
are  not  aware  that  this  has  ever  been  demonstrated  to  be 
true — yet  it  is  to  be  feared  that  for  the  origin  of  so  great  a 
discrepancy  of  numbers,  research  must  be  made  into  the  ha- 
bits and  customs,  the  physical,  mental  and  moral  condi- 
tion of  the  people  of  New-York  city.  If  this  be  true,  it  is 
not  believed  that  those  causes  are  peculiar  to  New- York, 
alone, but  that  they  are  common  to  all  great  commercial  settle- 
ments, and  thus  furnish  melancholy  evidence,  to  the  full  ex- 
tent of  the  signification  of  the  assertion,  that 

"  God  made  the  countiy  but  man  made  the  town." 

Of  one  thousand  and  thirty-eight  men,  but  thirty-six  were 
widowers.  This  is  equal  to  about  three-and-a-half  per  cent. 
Of  seven  hundred  and  eleven  women,  eighty,  or  a  little  more 
than  eleven  per  cent,  were  w^idows.  Hence,  the  relative  pro- 
portion of  the  latter  was  more  than  three  times  greater  than 
that  of  the  former.  It  is,  we  believe,  a  well  ascertained  fact 
that,  of  the  widowed  in  the  general  population  of  the  North- 
ern States,  there  are  more  women  than  men ;  yet  that  pre- 
dominance cannot  at  all  account  for  this  disproportionate 
number  among  the  insane.  Grief,  of  which  the  female  mind 
is  more  susceptible  than  that  of  man,  and  the  comparatively 
unprotected  and  dependent  condition  in  which  widows  are 
placed  by  the  loss  of  their  partners — a  position  peculiarly  ex- 
posing them  to  other  exciting  causes  of  mental  disorder — must, 
it  is  believed,  be  the  principal  sources  from  which  have  arisen 
this  large  number  of  insane  among  widowed  females. 


71 


SECTION    VII. 
OCCUPATION. 


How  far  the  diverse  occupations  of  men  may  severally  tend 
to  the  development  of  insanity,  either  as  a  remote  or  proxi- 
mate cause,  is  a  proposition  upon  which  but  little  light  has 
hitherto  been  thrown,  and  there  are  many  obstacles  in  the 
way  of  its  satisfactory  solution.  That  some  employments,  to 
a  greater  extent  than  others,  are,  from  their  very  nature, 
promotive  of  mental  disorder,  must,  even  by  a  superficial 
thinker,  be  acknowledged  ;  but  to  what  extent  the  one  may 
exert  its  influence  more  than  the  other,  cannot  so  easily  be 
ascertained. 

Of  the  one  thousand  and  ninety  men,  a  record  of  the  con- 
dition, in  regard  to  occupation,  of  but  one  thousand  and 
fifteen  has  been  preserved.  These  cases  are  arranged  be- 
low, an  attempt  having  been  made  to  classify  them  accord- 
ing to  the  similarity  of  their  several  employments.  This 
classification  is  necessarily  imperfect. 


1*^  Merchants  and  traders. 

Merchants,  traders, 
Merchants'  sons. 
Clerks,  .... 
Brokers, 
Auctioneers,  . 
Druggists  and  Apotheca- 
ries, 
Dealers  in  fur, 

do         paper, 

do        furniture, 
Upholsterers, 
Ironmonger,  . 
Ship  chandler,    . 
Steamboat  agent,  . 
Contractor, 
Supercargo,    . 


'S. 

2d.     Professional   7nen — per- 

11 

S071S    uhose    occupation    is 

2 

chiejiy  mental. 

62 

2 

Physicians,    .         .         .20 

2 

Lawj^ers, .         .         .           16 

Clergymen,    .         .         .10 

14 

Students,        ...     18 

2 

do         of  law,       .         10 

do         of  medicine,         5 

do         o^  theology,          2 

2 

Editors,           ...       4 

Diplomatists,      .         .           3 

Artist,    ....       1 

Surgeon  of  British  Navy,     1 

Civil  engineer,       .         .       1 

Teachers,    .          .         .14 

72 


3rf.    Members  of  the  Army 
and  Navy. 

Officers  in  Army,        .  5 

do          Navy,  .         .  3 

do          British  Army,  1 

Soldiers,     ...  2 

Ath.  Mariners. 

Sea  captains,          .  .     26 

Steamboat  captain,     .  1 

Mate  of  ship,         .  .       1 

Pilot,.         .         .         :  1 

Sailors,  .         .         .  .19 

Ship's  cook,  .  .  1 
Fisherman,    ...       1 

Boatman,   ...  2 

bth.  Persons  in  active  employ- 
ment out  of  doors. 

Farmers,  .  .  .193 
Farmers'  sons,  .  .  7 
Planters,     ...  3 

Gardeners,  ...  2 
Drover,       ...  1 

Milkman,  ...  1 
Hostler,      ...  1 

Laborers,  .  .  .41 
Masons  and  bricklayers,  1 1 
Stone  cutters,     .         .  2 

Tanners,     and    leather- 
dressers,  .     18 
Sheriffs,      ...  2 
Landing  officer  of  cus- 
toms, 
Constable,  . 
Dockmaster, 
Keeper  of  toll-gat 
Ship  carpenters, 
Rigger,       . 
Caulker, 
Boat  builder. 

Butchers,        .         .         .1 
Cartmen,    .         .         •         10 


Ferryman,     ...  1 

Lumbermen,       .         .  2 

Waterman,    ...  1 

Pedlars,      ...  4 

Keeper  of  light-house,  1 

Qth.  Active  employment  in- 
doors. 

Carpenters,  ...  30 

do         apprentices,  2 

Cabinet  makers,          .  1 1 

do         apprentices,  .  3 

Turners,     ...  2 

Block  makers,         .         .  2 

Carver,       ...  1 

Coopers,         ...  3 

Chair  maker's  apprentice,  1 

Plane  maker,      .         .  1 

Wheelwrights,       .         .  4 

Coach  makers,     .         .  4 

Machinists,    ...  5 

Locksmith,          •         .  1 

Cutler 1 

Quill  dresser,      .         .  1 
Gun  smith,     .         .         .1 

Stove  mounter,           .  1 

Tin  workers, ...  2 

Piano  maker,      .         .  1 

Trunk  maker,         .         .  1 

Reed  maker,       .         .  1 

Spinner,          ...  1 

Clothiers,    ...  2 

Paper  maker,         .         .  1 

Ink  maker,          .         .  1 

Millers,           ...  3 

Maltster,    ...  1 

Barber.  ....  1 

Potters,       .         .         •  2 

Printers,         ...  7 

Servants,    ...  6 

Porters,          ...  2 

Sculptors,  ...  2 

Dentist,        ...  I 


73 


dth.  Dealers  in  Liquor. 

Grocers,  .         .         .21 

Innkeepers,  .         .         3 

Tavernkeepers,        .         .     3 
Barkeeper,  .         .         1 

Billiard  room  keeper,      .     1 
Brewers,.      ...         3 

10th  Sedentary  Employments. 


Actor,  ...         1 

Bookbinder's  apprentice,      1 
Circus  rider,         .         .         1 

7th.  Exposed  to  Heat. 

Blacksmiths,         .         .  13 

Brassfounder,           .  .     1 

Bellfounder,          .         .  1 

Jronfounders,             .  .     4 

Grate  makers,      .         .  2 

Smith,     .         .         .  .     1 

Bakers,         ...  2 

Coffee  roaster,         .  .     1 

Hatters,        ,         .         .  9 

Hatter's  apprentice,  .     1 

Confectioner,        .         .  1 

Fuller,              ...  1 

8th.  Exposed  to  deletei'ious 
Vapors,  <^c. 

Workers  in  white  lead,  3 

Smelter  of  Copper,       .  1 

Chemists,          .         .  .3 

Painters,       ...  7 

Gilders,            .         .  .2 

Fancy  soap  maker,       .  1 

It  seems  impossible  to  derive  any  satisfactory  conclusions 
which  might  be  applicable,  on  broad  and  general  principles, 
from  these  tables.  The  occupation  of  the  inmates  of  any 
public  institution  must  partake,  in  its  general  features,  of 
that  of  the  community  in  its  vicinity.  Situated  as  the  Bloom- 
ingdale  Asylum  is,  within  the  limits  of  the  most  populous  city 
and  greatest  commercial  emporium  in  the  country,  it  must 
necessarily  be  supposed  that  a  large  portion  of  its  patients 
come  from  the  classes  engaged  in  trade  and  in  the  several 
professions.  Yet,  inasmuch  as,  for  many  years,  there  was 
no  other  institution  of  the  kind  in  the  State,  it  is  fair  to  pre- 
sume that  a  number,  not  inconsiderable,  are  derived  from 
the  agricultural  districts. 


Shoemakers, 

Tailors, 

Weavers, 

Saddlers, 

Do.  Apprentice, 

Watchmakers,  Jewellers, 

Mathematical    instrument 
maker, 

Sail  maker, 

Segar    makers,    tobacco- 
nists. 

Basket  maker, 


33 

17 
8 
6 
1 
6 

1 
1 

4 
1 


11th.  Men  of  Leisure,  and 
Young  Men  ivithout  Em- 
ployment,        .         .         55 


74 

Of  1015  patients  whose  occupation  is  here  recorded,  204 
were  merchants,  traders,  and  their  clerks.  This  is  a  little 
more  than  20  per  cent  of  the  whole. 

Of  professional  men  and  others  engaged  chiefly  in  mental 
occupations,  there  were  lOG,  or  a  trifle  more  than  10  per  cent. 

From  the  army  and  navy,  there  were  11,  which  is  a  small 
fraction  more  than  1  per  cent. 

Of  mariners,  the  number  was  52,  or  a  little  more  than  5 
per  cent. 

In  the  class  of  persons  engaged  in  active  employment  out 
of  doors,  there  were  322,  or  31  and  7-10  per  cent.  This  class, 
however,  includes  people  of  various  occupations,  in  both  city 
and  country;  212  of  them  were  directly  engaged  in  agricul- 
tural pursuits.  This  is  a  small  fraction  more  than  20  per 
cent  of  the  whole  number.  The  remainder  were  mostly 
from  the  city,  although,  under  the  term  "  laborer,"  it  is  prob- 
able that  some  from  the  rural  districts  are  included. 

In  the  class  of  active  employment  within  doors,  the  num- 
ber is  111,  or  something  more  than  10  percent. 

This  division  also  includes  a  great  variety  of  occupations. 
Of  carpenters,  cabinet  makers  and  other  workers  in  wood, 
there  w^ere  G4,  or  6  and  3-10  per  cent  of  the  whole  number. 
Much  of  the  labor  of  carpenters  is  out  of  doors,  but  it  was 
thought  they  were  more  properly  arranged  under  this  class 
than  any  other. 

In  the  class  of  persons  whose  employment  subjects  them, 
in  a  greater  or  less  degree,  to  an  elevated  artificial  tempera- 
ture, there  were  37,  or  3  and  0-10  per  cent. 

Of  those  who,  in  their  vocation,  are  subjected  to  the  dele- 
tereous  action  of  metals,  either  in  the  form  of  vapor  or  other- 
wise, there  were  16.     This  is  about  1  and  6-10  per  cent. 

There  were  32  dealers  in  liquor,  a  number  equivalent  to 
3  and  1-10  per  cent. 

It  may  be  remarked  that,  under  the  term  "  grocer"  are  in- 


75 

eluded  some  whose  prineipal  business  was  the  mixing  and 
retailing  of  spirituous  liquors. 

In  that  division  the  occupations  of  which  are  mostly  of  a 
sedentary  character,  there  are  08,  or  6  and  7-10  per  cent. 

Of  men  of  leisure  and  young  men  without  employment, 
there  were  55,  or  5  and  4-10  per  cent. 

OCCUPATION    OF    FEMALES. 

Of  the  751  female  patients,  the  condition,  in  regard  to  oc- 
cupation, of  but  241  is  recorded.  Of  these,  the  most  import- 
ant are  as  follows : 


Seamstresses,     .         .         52 

Hucksters, 

.     2 

Servants,        .         .         .51 

Pawnbroker, 

1 

Teachers,     .         .         '         9 

Cook, 

.     1 

Grocers  &  tavern  keepers,   5 

Farmers' wives,  . 

24 

Nurses,             .         .         .3 

Mechanics'  do. 

.    U 

paper  folders,       .         .         2 

Farmers'  daughters,    . 

20 

Workers  in  factory,         .     2 

The  rest  were  mostly  the  wives  and  daughters  of  persons 
engaged  in  a  variety  of  employments.  Of  the  510  whose  oc- 
cupation is  not  stated,  it  is  probable  that  most  of  them  were 
from  the  non-laboring  classes  of  society. 


76 


SECTION    YIII. 
CAUSES     OF      INSANITY. 

It  was  formerly  customary  with  authors  on  mental  alien- 
ation, to  separate  those  agents  or  influences  producing, 
or  believed  to  be  productive  of  the  disease,  into  remote  and 
proximate,  predisposing  and  exciting  causes.  Of  late  years, 
and  particularly  in  the  annual  reports  made  out  by  the  phy- 
sicians of  the  institutions  for  the  insane,  that  custom  has 
fallen  pretty  generally  into  disuse. 

In  many  of  the  cases  of  insanity,  it  is  extremely  difficult  to 
fix  upon  any  particular  influence  which  we  are  satisfied  was 
the  origin  of  the  disorder.  Sometimes  two  causes  are  found, 
and  it  is  impossible  to  tell  which  is  the  predisposing  and 
which  is  the  exciting.  That  power  which  in  one  case  may 
stand  in  the  relation  of  a  remote  cause,  may,  in  another,  be- 
come the  proximate. 

If,  therefore,  in  regard  to  many  of  the  causes,  the  modern 
writers  have  adopted  the  safest,  and  not  improbably  the  most 
accurate  method,  by  embodying  all  the  generative  influences 
of  the  disease  into  one  class,  and  avoiding  the  endeavor  to 
make  a  division  where  it  is  impossible  to  draw  an  accurate 
line  of  demarkation,  they  have,  perhaps,  in  reference  to  some 
others,  fallen  into  error. 

That  constitutional  condition  of  the  system  transmitted 
from  one  generation  to  another — a  condition  which,  although 
recondite  in  its  nature,  facilitates,  to  a  greater  or  less  extent, 
the  invasion  of  mental  derangement,  and  is  generally  known 
by  the  term  hereditanj  predisj}osition,  is  invariably  a  remote 
or  predisposing  cause.  According  to  our  belief,  wherever 
this  natural  condition  exists,  the  person  will  retain  the  healthy 
action  of  his  mind  until  he  is  subjected  to  some  other  influ- 
ence, more  immediate,  more  active,  more  potent,  and  the  ten- 


77 

dency  of  which  is,  so  to  derange  the  physical  functions  of  the 
system  as  to  impair  the  manifestation  of  the  mental  powers. 

For  the  reasons  stated,  we  enter  upon  the  subject  of  here- 
ditary predisposition  before  proceeding  to  other  causes. 

In  making  up  the  statistics  upon  this  subject,  the  relatives 
known  to  have  been  insane  are  given  in  full,  instead  of  in- 
cluding the  whole  number  of  cases  under  the  general  term 
hereditary.  Of  the  fifty-eight  males  and  thirty-nine  females 
placed  against  that  term,  in  the  subjoined  tables,  the  simple 
fact  that  an  inherited  tendency  existed,  is  mentioned  upon 
the  records,  but  the  particular  ancestor  or  ancestors  who 
were  insane,  are  not  stated. 


MALES. 

\st.  Predisposition  from  direct  Ancestors. 

Hereditary, 

Hereditary,  and  sister  insane. 

Hereditary,  and  brother  and  sister  insane. 

Hereditary,  and  daughter  insane. 

Hereditary,  and  brother 

Father 

Father  and  mother 

Father  and  brother 

Father  and  sister 

Father,  brother,  sister  and  other  relatives  insane, 

Father,  brother  and  sister,  " 

Father,  two  brothers  and  sister  " 

Father,  only  brother  and  only  sister  " 

J'ather,  brother  and  two  paternal  uncles       " 

Father  and  daughter  " 

Father  and  nephew  " 

Mother 

Mother  and  brother  " 

Mother  and  sister  " 

Mother  and  aunt  " 

Mother,  mateftial  aunt  and  cousin  " 

Mother  and  paternal  cousin  " 

Mother  and  paternal  grand-father  " 

Mother  and  several  of  the  family  " 


58 
1 
I 
1 
1 

14 
1 
2 
1 
1 
2 
1 
1 
1 

1 
12 
4 
2 
1 
1 
1 
1 
3 


78 


Grand-father 

Maternal  grand-father,  brother  and  sister 
Maternal  grand- father  and  three  sisters 
Paternal  grand-mother 


"  1 

1 
1 
1 

Total,         118 


2nd.  Predisposition  as  connected  with  collateral  Relatives, 


Brother  insane, 

10 

Two  brothers  insane, 

3 

Brother  and  other  relatives  insane, 

Brother  and  cousin        .            " 

1  . . 

Sister                                           " 

••.-:                    <y 

Two  sisters  insane, 

Sister  and  several  of  the  family  insane, 

Brother  and  sister 

« 

2 

Several  brothers  and  sisters 

« 

2 

Uncle 

a 

4 

Uncle  and  several  others  of  family 

insane, 

2 

Paternal  uncle  and  cousin 

u 

1 

Aunt 

i( 

1 

Aunt  and  daughter 

u 

1 

Grand-father's  sister 

« 

1 

Cousin 

« 

4 

Two  cousins 

u 

1 

One  of  mother's  family 

« 

1 

Some  of  mother's  family 

(( 

4 

Most  of  maternal  relatives 

« 

1 

Some  of  family 

M 

2 

Several  of  family 

ti 

11 

Whole  family 

U 

1 

Having  family  predisposition 

it 

,4 

Distant  relative 

ii 

1 

Total,     68 

Descendants. 

Daughter  insane, 


FEMALES. 

1st.  Predisposition  from  direct  Ancestors. 

Hereditary,  39 

Hereditary  and  brother  insane,  1 

Hereditary  and  a  cousin     "  1 

Hereditary,  a  son  and  several  of  family  insane,  1 

Father  "  6 

Father  and  mother  "  1 

Father  and  grand-father  "  1 

Father,  grand-father  and  paternal  aunt  insane,  1 

Father,  paternal  uncle  and  cousin  "  2 

Father  and  three  uncles  "  1 

Father  and  brother  "  2 

Father  and  sister  *'  3 

Father  and  four  step-brothers  "  1 

Mother  "  15 

Mother  and  grand-father  "  1 

Mother  and  all  her  family  "  1 

Mother  and  two  uncles  "  1 

Mother  and  aunt  "  1 

Mother  and  two  paternal  aunts  "  1 

Mother  and  brother  "  2 

Mother,  brother  and  sister  "  1 

Mother,  brother  and  two  sisters  "  1 

Mother  and  sister  "  2 

Grand-father  "  1 

Paternal  grandrfather  and  his  brother  "  1 

Paternal  grand-mother,  uncle  and  aunt     "  1 

Total,     89 

2nd.  Predisposition  as  connected  with  collateral  Relatives. 

Brother  insane,                            .                          .  4 

Brother  and  several  of  family  insane,  .                 •         1 

Sister                                                "  9 

Sister  and  several  of  family         "  2 

Two  sisters                                      "  1 

Paternal  uncle                                 "  1 

Paternal  uncle  and  cousin             "  1 

Aunt                                                   "  1 

Maternal  aunt                                  "  2 

Maternal  aunt  and  brother           "  1 


80 

Paternal  aunt  and  maternal  uncle  insane, 

Cousin  " 

Two  cousins  " 

One  of  family  " 

Several  of  family  " 

A  distant  branch  of  family  " 

Several  of  grand-father's  family  " 

All  of  father's  family  " 

Having  family  predisposition  4 

Total,  ~i2 

Descendants. 

Son  insane,  .....  2 

Daughter  insane,  .  .  .  .  .2 

Two  children  insane,  .  .  -.  .  1 

Thus,  of  eighteen  hundred  and  forty-one  patients,  three  hun- 
dred and  twenty-three — of  whom  one  hundred  and  eighty- 
seven  were  males,  and  one  hundred  and  thirty-six  females — 
are  recorded  as  having  one  relative  or  more,  insane  ;  this  is 
equivalent  to  seventeen  and  a-half  per  cent.  The  per  cent- 
age  in  each  sex,  taken  separately,  is  as  follows:  men,  17  and 
16-100;  women,  18  and  11-00 

It  is  not  to  be  presumed,  however,  that  this  is  even  a  near 
approximation  to  the  number  actually  haA^ng  relatives  of 
disordered  mental  powers.  During  the  first  few  years  of  the 
existence  of  the  Asylum,  there  appears  to  have  been  but  lit- 
tle attention  paid  to  this  particular  subject,  and  hence  the 
records  thereupon  are  imperfect.  There  are  other  important 
obstacles  in  the  way  to  a  correct  knowledge  of  the  full  extent 
to  which  the  hereditary  predisposition  prevails  among  the 
patients  admitted  into  a  public  institution.  These  obstacles 
may,  by  perseverance,  be  measurably  overcome. 

Insanity  being  a  disordered  manifestation  of  the  mind,  de- 
pendant upon  some  disease  of  the  body,  either  functional  or 
organic,  is  governed  by  the  same  laws  as  many  or  most  other 
maladies  to  which  the  human  race  is  subject.  Like  con- 
sumption, gout,  diseases  of  the  liver  and  of  the  heart,  it  may 


81 

attack  any  person  whatever,  but  it  is  certainly  somewhat 
more  likely  to  prevail  among  those  whose  ancestors  have 
suffered  from  it. 

Of  the  men  included  in  the  foregoing  table,  one  hundred 
and  eighteen  inherited  the  predisposition  from  direct  ances- 
tors, and  thirty-three  of  these  had  other  relatives  insane.  Of 
the  remainder,  sixty-eight  had  collateral  relatives  insane,  but 
no  direct  ancestors ;  and  one  had  a  child  insane.  Of  the 
fifty-two  who  had  iAsane  parents,  it  was  the  father  in  twenty- 
seven  cases,  and  the  mother  in  twenty-five.  In  one  of  these, 
both  father  and  mother  had  been  deranged.  It  is  also  stated, 
that  two  of  those  included  under  the  term  hereditary,  had  an- 
cestors, both  paternal  and  maternal,  who  were  subject  to  the 
malady. 

Of  the  women,  the  predisposition  was  transmitted  from 
direct  ancestors  in  eighty-nine  ;  of  whom  sixty-seven  had 
other  relatives  insane.  In  the  remaining  forty-two,  the  dis- 
ease is  stated  to  have  appeared  only  in  persons  collaterally 
connected  ;  and  in  five  cases  in  their  children  alone.  There 
are  eighteen  cases  in  which  it  is  mentioned  that  the  father 
was  insane.  In  one  case  the  father  and  mother  were  both 
deranged.  In  the  case  where  it  is  asserted  that  the  whole 
family  were  insane,  it  is  said  that  all  her  father's  family, 
which  consisted  of  twelve  children,  have  been  deranged,  and 
that  their  insanity  did  not,  in  a  single  instance,  make  its  ap- 
pearance before  the  age  of  twenty-one  years.  Two  of  her 
brothers,  while  insane,  committed  suicide.  None  of  the  third 
generation  have  yet  been  attacked  with  mental  disorder,  al- 
though several  of  them  have  passed  the  age  at  which  it  made 
its  appearance  in  the  second. 

In  the  following  schedule  are  arranged  those  instances  in 
which  more  than  one  member  of  a  family  have  been  inmates 
of  this  institution : 


82 


Two  brothers  were  patients  here  in  7  instances. 
Three  brothers  E"  "  "     "  2 


2 


A  brother  and  )    ^^  ^^  ^^ 

sister  \ 

Two  sisters  "  "  "     »  3         " 

Two  sisters     ^ 
and  two  of  their  >  "  "  "     "  1         " 

cousins  ) 

Mother  and  son  "  "  "     "  3         " 

Father  and  son "  "  "     "  1         " 

Father,  dau'-  )   ,.  ..  ,.     , 

ter  and  her  son   ) 

Mother   and    )  ,,  ,,  ,,     ,, 

daughter  ) 

Uncle  and  niece  "  "  "     "  1         " 

In  one  of  the  cases  of  three  brothers,  their  father  was  in- 
sane, and  one  of  their  sisters  has  been  admitted  as  a  patient 
since  the  period  at  which  these  statistics  close. 

In  one  of  the  cases  of  two  brothers,  it  is  stated  that  they 
had  several  other  brothers  and  sisters  insane.  In  one  of  the 
other  cases  of  two  brothers,  the  family  consisted  of  but  four 
brothers,  and  they  all  labored  under  the  same  disease. 

In  one  case  of  a  woman  admitted  previously  to  1844,  her 
son  has  been  received  since  that  time. 

In  one  instance  in  which  a  young  man  was  the  only  mem- 
ber of  the  family  admitted  into  the  Asylum,  it  is  stated  that 
his  father  and  two  of  his  father's  brothers  were  deranged, 
and  all  of  them,  as  well  as  himself,  had  hernia. 

It  is  obvious  that  the  foregoing  statistics  are  not  sufficient- 
ly full  or  definite  to  be  adopted  as  accurate  data  from  which 
to  estimate  the  proportion  of  the  insane  in  vrhom  an  inherent 
predisposition  exists,  the  comparative  number  in  whom  it  is 
transmitted  from  the  father's  or  the  mother's  side,  or  any  of 
the  other  important  questions  involved  in  the  subject. 

In  some  persons,  although  none  of  their  family,  cither  in 
a  direct  line  or  an  immediately  collateral  branch,  may  have 


83 

ever  suffered  from  mental  disease,  there  is  a  natural  idiosyn- 
crasy or  peculiarity  of  constitution  which  facilitates  the  in- 
vasion of  insanity.  This  peculiarity  probably  exists  in  the 
intimate  structure  of  the  nervous  system,  although  Dr.  Rush 
appears  to  have  thought  it  to  be  in  the  blood.  In  which  sys- 
tem of  organs  soever  it  may  be,  it  is  probably  very  similar  in 
its  nature  to  that  which  constitutes  the  hereditary  predispo- 
sition, and  in  this  way  the  latter  springs  up  in  families  among 
whose  members  it  has  never  before  appeared. 

This  constitutional  habit  is,  apparently  at  all  times,  merely 
a  predisposing  condition,  and  never  generates  insanity  unless 
assisted  by  some  more  exciting  cause.  In  some  of  the  pa- 
tients, the  existence  of  this  constitutional  predisposition  is 
mentioned,  but  the  number  is  few,  and  therefore  has  not  been 
embodied  in  these  statistics. 

In  idiocy,  properly  so  termed,  the  mental  disease  or  imper- 
fection exists  without  the  intervention  of  any  external  influ- 
ence, the  person  being  born  in  that  condition.  By  consulting 
the  table  in  which  the  form  of  disease  is  recorded,  it  will  be 
perceived  that  fourteen  of  the  patients  were  of  this  class. 
Twenty-three  more  are  arranged  under  the  head  of  imbecili- 
ty.    In  some  of  these  also  the  disease  was  congenital. 

There  are  one  thousand  one  hundred  and  eighty-six  pa- 
tients, the  causes  supposed  to  have  been  productive  of  whose 
disease  are  recorded.  These  are  arranged  in  the  following 
tables,  being  divided  according  to  the  general  method,  into 
physical  causes  or  those  which  act  immediately  upon  the 
body,  and  mental  causes  or  those  whose  influence  is  prima- 
rily exerted  upon  the  mind. 


84 


ALLEDGED    CAUSES    OF    DISEASE. 


1st.  Physical. 

Intemperance,  .-.._^.  — .- .... 

Dissipation, .._^ 

Syphilis, — ^_. 

Use  of  opium, .  .. 

Cerebral  disease, .._„...^ 

Epilepsy, •,-.-:--- ^ 

Chronic  arachnoiditis, .^ 

Cerebral  congestion,  .. ........  .^ 

Phrenitis, --^ 

Injuiy  from  falls, -  -  ^. 

"     of  spine, 

Disease  of  spine  and  heart,  .. 

Gun-shot  wound, „ 

Punctured  wound, 

Kick  on  stomach,  from  horse, 

Insolation,  and  heat  from  sun.  . .  _ 

"  and  drinking  cold  water. 

Masturbation, 

Connected  with  puberty, 

Nervous  debility, 

Bodily  exertion, 

Nursing,  loss  of  sleep,  &c.  . 

Mesmerism, _^. 

Neuralgia, 

111  health,.  — 

Fever, „. . 

"     typhus  and  typhoid 

*'     bilious, 

"     intermittent,. 

"     yellow, . . 

Dyspepsia, 

Disease  of  liver, 

Rheumatism, 

Gout, .. 

Phthisis, 

Repelled  eruptions 

Suppressed  hemonhoids, . .  .^ , 

"  perspiration,. , 

"  secretions, 

Healing  of  fistula, 

Measles, .  .  .  ...^^.^ 

Scarlatina, 

Erysipelas, 


M. 


F, 


97 

20 

9 

0 

1 

0 

5 

8 

30 

4 

19 

4 

3 

1 

1 

1 

5 

1 

28 

3 

1 

0 

0 

1 

1 

0 

0 

1 

1 

0 

8 

0 

1 

0 

37 

0 

7 

2 

1 

3 

4 

0 

0 

7 

1 

0 

1 

0 

20 

17 

20 

11 

5 

2 

11 

5 

3 

2 

5 

3 

16 

10 

5 

3 

2 

1 

1 

0 

3 

5 

5 

2 

2 

0 

2 

0 

0 

1 

2 

0 

2 

3 

1 

1 

1 

2 

T. 

117 

9 

1 

13 

34 

23 

4 

2 

6 

31 

1 

1 

1 

1- 

1 

8 

1 

37 

9 

4 

4 

7 

1 

1 

37 

31 

7 

16 

5 

8 

26 

8 

3 

1 

8 

7 

2 

2 

1 

2 

5 

2 

3 


85 

Small-pox, 

Varioloid, —  - 

Working  in  white  lead 

Acetate  of  lead, 

Metallic  vapor, 

Vapor  of  prussic  acid, 

Sedentary  life 

Dysentery, 

Old  age, 

Pregnancy,   

Parturition, 

Lactation, 

Abortion, 

Irregular  menstruation, 

Menorrhagia, 

Amenorrhea,  ......... .- 

Suppression  of  menses  at  change  of 

life,  

Uterine  disorder, -. 

Hysteria, - -  —  - 

Total, 

2d.  Moral   Causes. 


Pecuniary  difficulties, 

Want  of  employment, 

Religious  excitement,  &c. 

Remorse, 

Death  of  relatives, 

Disappointed  affection, — 

Home-sickness, 

Application  to  study,  .... 

Mental  excitement 

Fright,  fear, 

Mental  shock,  —  ^. 

Domestic  trouble, . . « 

Anxiety,   

Mortified  pride, 

Disappointed  ambition,  . . 

Disappointment, 

Faulty  education,  . 

Ungoverned  passions, 

Avarice, 

Jealousy, 

Seduction,  

Novel  reading,  ... .. 

Dealing  in  lottery  tickets, 

Total,  .^^ 


M. 

F. 

1 

0 

1 

1 

5 

0 

2 

0 

1 

0 

1 

0 

0 

3 

0 

1 

1 

1 

0 

16 

0 

66 

0 

12 

0 

5 

0 

1 

0 

1 

0 

28 

0 
0 

10 
14 

0 

2 

379 

285 

T. 
1 

2 
5 
2 

1 

1 

3 

1 

2 

16 

66 

12 

5 

1 

1 

28 

10 

14 

2 


M. 

F. 

118 

15 

11 

0 

51 

42 

5 

6 

16 

27 

12 

26 

2 

1 

30 

0 

6 

0 

4 

15 

2 

0 

22 

43 

12 

10 

8 

6 

3 

1 

1 

2 

4 

4 

1 

3 

1 

0 

1 

4 

0 

3 

0 

3 

0 

1 

310 

212 

664 


T. 

133 

11 

93 

11 

43 

33 

3 

30 

6 

19 

2 

65 

22 

14 

4 

3 

8 

4 

1 

5 

3 

3 

1 


86 

Of  the  patients  whose  disease  was  supposed  to  have  origi- 
nated from  physical  causes,  there  were  064  ;  of  whom  379 
were  males,  and  285  females.  Of  those  supposed  to  have 
arisen  from  moral  causes,  there  were  522  ;  310  males,  and 
212  females. 

Almost  all  the  older  authors  upon  insanity  believed  that 
mental  causes  were  more  prolific  of  the  disease  than  physi- 
cal. Within  a  few  years,  however,  the  opposite  opinion  has 
been  gaining  ground, — an  opinion  which  is  sustained  by 
these  statistics. 

It  will  be  perceived  that,  although  a  distinct  .class  has 
been  made  of  all  the  cases  of  delirium  tremens,  intemperance 
occupies  the  highest  rank,  in  point  of  numbers,  among  the 
physical  causes.  So  far  as  this  item  is  concerned,  the  table 
may  undoubtedly  be  taken  as  a  criterion  by  which  to  judge 
of  the  comparative  influence  of  the  various  agents  produc- 
tive of  insanity  in  this  country. 

Thirteen  cases,  of  which  five  were  men  and  eight  women, 
resulted  from  the  excessive  use  of  opium.  In  one  of  the  men, 
the  cause  was  more  fully  stated  as  the  "  too  abundant  indul- 
gence in  opium,  snuff  and  tobacco,"  The  action  of  these  nar- 
cotic substances  upon  the  nervous  system  is  very  similar  to 
that  of  alcoholic  liquors,  and  a  recent  French  writer  not  only 
maintains  that  this  action  is  precisely  the  same,  but  asserts 
that  he  has  proved  it  to  be  so.  If,  therefore,  one  of  the  ne- 
cessary effects  of  alcohol  is  to  establish  in  the  system  a  con- 
dition which  will  prevent  the  healthy  action  of  the  mind, — 
and  we  are  but  too  well  aware  that  this  is  the  fact, — it  fol- 
lows that  the  narcotics  in  question  would  produce  an  identi- 
cal effect,  and  cause  insanity.  No  one,  it  is  presumed,  will 
question  the  truth  of  this  proposition  so  far  as  relates  to 
opium.  In  reference  to  tobacco,  there  may  be  some  doubt. 
Several  modern  authors,  however,  concur  in  the  belief  that, 
when  excessively  used,  it  may  be  the  principal  cause  of  men. 


87 

tal  derangement,  and  cases  thus  produced  have  been  report- 
ed at  a  number  of  institutions. 

The  immediate  action  of  this  substance  upon  the  nervous 
system,  in  persons  of  a  highly  excitable  temperament,  is  so 
powerful  that,  when  smoking,  they  feel  a  peculiar  sensation 
or  thrill  even  to  the  remotest  extremities  of  the  limbs.  A 
constant  stimulus  of  this  kind,  upon  a  nervous  temperament, 
can  hardly  be  otherwise  than  deleterious.  Tobacco,  particu- 
larly when  used  by  smoking,  tends  to  disturb  the  functions  of 
the  liver  ;  and  disordered  action  of  this  organ  is  not  an  un- 
frequent  cause  of  mental  disease.  It  also  produces,  or  assists 
in  producing,  a  chronic  inflammation  of  the  mucous  membrane 
of  the  alimentary  canal.  The  inflammation  of  this  membrane 
may  become  the  cause  of  mental  disturbance.  Again,  par- 
ticularly in  persons  in  whom  it  excites  an  inordinate  secre- 
tion from  the  salivary  glands,  tobacco  is  likely  to  produce  dys- 
pepsia, a  disease  which,  more  than  almost  any  other  whose 
action  is  sympathetica!  upon  the  brain,  affects  the  manifesta- 
tions of  the  mind. 

Who  has  not  experienced  or  observed  this  deleterious  in- 
fluence, producing  depression  of  spirits,  dejection,  taciturnity 
and  inability  to  contend  with  the  cares  of  life  ;  gloom,  des- 
pondency, and  perhaps  a  disposition  to  self-destruction,  or  ac- 
tual insanity  in  the  form  of  melancholia  ? 

How  little  or  how  much  soever  tobacco  may  act,  either 
inmiediately  or  remotely,  as  a  generative  cause  of  insanity,  it 
is  a  fact  well  known  to  all  connected  with  public  institu- 
tions of  this  kind,  that  there  is  no  stimulant  or  narcotic  sub- 
stance in  which  the  insane  are  more  prone  to  indulge.  If 
within  their  reach,  those  who,  previously  to  becoming  insane, 
have  been  accustomed  to  it,  will  use  it  to  excess,  and  many  or 
most  of  those  who  have  not  before  been  addicted  to  the  habit, 
soon  fall  into  it.  One  man  included  among  the  patients  re- 
maining in  the  institution  at   the  time  these  statistics  close 


88 

kept  constantly  in  his  mouth,  both  day  and  night,  excepting 
when  at  meals,  a  quid  of  tobacco  frequently  nearly  as  large 
as  an  ordinary  hen's  egg.  Whatever  saliva  it  might  have 
produced  was  rarely,  if  ever,  ejected  from  the  mouth,  but  usu- 
ally swallowed.  He  had  been  in  the  institution  during  the 
whole  period  of  its  existence,  being  one  of  those  who  were 
brought  from  the  old  Asylum.  He  had  been  accustomed  to  the 
habit  for  many  years ;  and  it  might  almost  be  said  of  him 
that, — 

"  Like  to  the  Pontic  monarch  of  old  days, 

He  fed  on  poison,  and  it  had  no  power, 

But  was  a  kind  of  nutriment." 

Athough  as  completely  insane  and  incoherent  as  it  is  pos- 
sible for  a  human  being  to  be,  he  worked  regularly,  doing 
about  as  much  as  any  ordinary  laborer.  The  tobacco  ap- 
peared to  have  a  soothing  and  controling  effect  upon  him» 
enabling  him  to  concentrate  his  powers  upon  the  labor  in 
which  he  was  employed.  If  deprived  of  it  for  a  few  hours, 
he  became  restless,  agitated,  excited,  talkative,  and  unable  to 
apply  himself  to  his  occupation.  In  this  respect,  the  narcotic 
had  an  effect  upon  him,  opposite  to  that  which  it  produces 
upon  many  of  the  insane.  It  frequently  increases  their  excite- 
ment, and,  in  some  instances,  to  a  remarkable  degree.  Its 
action,  upon  the  whole,  is  considered  so  deleterious  that,  in 
most  of  the  well  conducted  establishments  for  the  insane  in 
this  country,  its  use  among  the  patients  is  prohibited.  At  this 
institution  it  is  not  permitted,  excepting  in  a  few  cases,  in 
small  quantities,  by  patients  who  have  resided  here  many 
years. 

There  are  sixty-nine  cases  included  under  the  several 
causes,  the  names  of  which  imply  an  organic  lesion  of  the  br^in 
or  its  membranes.  According  to  our  belief,  there  is  always 
cerebral  disease  in  insanity ;  and  such  alone  has  the  power 
to  affect  the  manifestations  of  the  mind.     In  some  cases  this 


89 

disease  is  organic,  but  in  the  majority  merely  functional, 
the  healthy  action  of  the  brain  being  disturbed  by  its  inti- 
mate sympathy  with  other  organs  which  are  diseased.  In 
many  cases  it  is  absolutely  impossible  for  the  most  experi- 
enced and  expert  observer  to  decide,  in  the  early  stages  of  in- 
sanity, whether  the  disorder  of  the  brain  be  organic  or  func- 
tional. Hence  it  is  possible  that  the  number  of  cases  here  at- 
tributed to  the  several  diseases  of  the  brain,  is  not  sufficiently 
large. 

Thirty-one  cases  are  recorded  as  having  originated  from 
injuries  produced  by  falls.  The  effect  of  sudden  shocks  or 
concussions  of  this  kind,  falls  most  heavily  upon  the  brain 
and  nervous  system.  Hence  their  agency  in  the  production 
of  mental  disorder  is  most  obvious. 

If  the  prick  of  a  pin  or  needle  may,  as  it  frequently  has 
done,  exert  so  potent  an  influence  upon  the  nervous  system 
as  to  result  in  that  terrible  disorder  popularly  known  as  the 
lock-jaw,  it  is  certainly  not  remarkable  that  a  punctured  or 
a  gun-shot  wound  should  cause  insanity.  One  case  arising 
from  each  of  these  causes  is  mentioned  above. 

One  case  is  also  recorded  as  the  effect  of  a  kick,  by  a 
horse,  upon  the  region  of  the  stomach.  Here,  the  disorder 
of  the  brain  was  undoubtedly  secondary  to  the  immediate 
effect  upon  the  great  central  plexus  of  the  sympathetic  nerve, 
in  the  region  receiving  the  shock. 

After  the  cases  of  insolation,  there  is  a  series  of  causes' 
all,  or  nearly  all  of  which  exhaust  the  nervous  power,  occa- 
sion debility,  and,  probably  by  this  means,  destroy  the  healthy 
exercise  of  the  brain.  The  first  of  these  is  masturbation. 
Thirty-seven  cases  are  placed  against  this  as  their  exciting 
cause.  For  a  long  time,  this  has  been  known  as  one  of  the 
many  agents  tending  to  destroy  the  balance  of  the  mind,  but 
it  is  not  until  within  a  few  years  that  its  influence  was  sup- 
posed to  be  so  great  as  it  is  at  present  by  most  physicians  to 
6 


90 

institutions  for  the  insane.  Although  it  is  acknowledged  to 
be  a  prolific  cause,  yet  there  is  danger  of  misapprehension 
upon  this  point.  The  habit  is,  undoubtedly,  in  many  cases, 
the  effect  of  the  disease. 

The  important  revolution  which  the  system  of  both  males 
and  females  undergoes  at  the  time  of  puberty,  sometimes 
seriously  affects  the  mind  and  produces  absolute  insanity. 
The  tendenc)'"  of  this  change  to  operate  upon  the  healthy 
action  of  the  mental  powers,  is  greatly  increased  by  the 
simultaneous  disposition  to  rapidity  of  growth.  When  the 
nutritive  vessels  are  acting  with  such  energy,  and  all  parts 
of  the  frame  are  becoming  developed  with  an  unwonted 
rapidity,  the  texture  of  the  body  is  loose,  incompact  and 
light,  wanting  the  density,  tone  and  stability  essential  to  a 
vigorous  performance  of  its  functions  ;  and  th©  nervous  fluid 
cannot  act  with  the  celerity  and  vigor  requisite  to  perfect 
health. 

Four  cases  of  men  and  seven  of  women  are  attributed  to 
excessive  bodily  exertion  and  loss  of  sleep. 

The  renovation  of  energy  by  sleep,  is  absolutely  essential 
to  the  healthy  exercise  of  both  the  physical  and  the  mental 
powers.  So  important  is  its  position  as  a  preventive  to  men- 
q).  derangement,  that  were  we  called  upon  to  give  advice  to 
all  who  are  predisposed  to  insanity,  are  threatened  with  it, 
or  fearful  of  it,  and  were  we  obliged  to  give  that  advice  in 
the  briefest  possible  terms,  we  would  concentrate  it  into  an 
imperative  phrase  of  but  two  words,  "  sleep  enough." 

Nothing  exhausts  the  nervous  energies  of  the  system  more 
rapidly  than  constant  and  prolonged  watching.  It  subverts 
a  primary  law  of  nature — a  law  which  cannot  be  seriously 
infringed  with  impunity. 

Excessive  bodily  exertion  wearies  the  frame  by  its  hea\7" 
tax  upon  the  nervous  system.  The  muscles,  it  is  true,  are 
he  immediate  organs  of  motion,  and  consequently  of  labor. 


91 

but  they  are  inert  and  incapable  of  movement  if  deprived 
of  the  nervous  stimulus.  If  a  constant  supply  of  the  latter 
could  be  continued  for  an  indefinite  period,  we  can  perceive 
no  sufficient  reason  w^hy  the  muscles  should  not  perform 
their  office  with  all  their  energy,  unweariedly.  At  least, 
the  converse  of  this  proposition  has  never,  so  far  as  we 
are  informed,  been  demonstrated. 

Inordinate  and  prolonged  labor  reduces  the  nervous  energy, 
and  rest  and  sleep  become  necessary  to  its  renewal.  But  it 
is  frequently  reduced  to  so  low  a  point  that  sleep  becomes 
impossible,  or,  if  at  length  it  be  attained,  it  is  imperfect,  bro- 
ken and  insufficient  to  enable  the  nervous  system  to  rally  its 
wonted  forces.  Hence,  in  these  cases,  it  may  be  not  so  much 
the  bodily  exertion  itself,  as  its  secondary  effect,  the  depriva- 
tion of  sleep,  which  is  the  immediate  cause  of  mental  dis- 
order. 

One  case  is  said  to  have  arisen  from  "  Mesmerism."  This 
was  the  cause  assigned  by  one  of  the  parents  of  the  patient. 
The  leading  features  in  the  history  of  the  case,  are  as  fol- 
lows :  The  patient  was  a  young  man,  about  twenty  years  of 
age,  of  a  highly  nervous  temperament,  with  a  brain  remark- 
ably developed  and  corresponding  intellectual  powers.  For 
several  years  he  had  suffered  from  occasional  epileptic  fits, 
which,  as  yet,  had  left  his  mind  but  little  if  at  all  impaired. 
The  skill  of  many  physicians  and  the  virtues  of  every  medi- 
cal resource  believed  to  be  applicable  to  such  cases,  had  been 
exhausted  upon  him  without  benefit.  As  a  dernier  resort, 
and  at  a  period  when  he  was  in  a  state  of  comparative  stu- 
por, such  as  frequently  follows  a  succession  of  epileptic  fits, 
he  was  placed  undfer  the  care  of  a  person  professedly  prac- 
tising "  Mesmerism"  for  the  cure  of  disease.  To  use  the  ex- 
pression of  this  person,  "  the  patient  was  magnetized  daily, 
for  nearly  a  month"  without  effect,  he  remaining  in  the  torpid 
condition  already  mentioned.    At  length  he  was  suddenly 


92 

roused,  appeared  rational  for  a  few  hours,,  and  then  passed 
into  a  state  of  high  excitement  and  absolute  mania.  A  day 
or  two  afterwards  he  was  brought  to  the  Asylum,  with  his 
arms  and  legs  strongly  bound.  When  admitted,  he  talked 
but  little  and  that  little  was  perfectly  devoid  of  meaning. 
He  was  highly  excited,  his  face  flushed  and  the  veins  of  his 
head  swollen ;  the  circulation  rapid,  the  pulse  being  frorrf 
one  hundred  and  twenty  to  one  hundred  and  forty  per  minute, 
the  tongue  furred,  and  the  bowels  very  much  constipated. 
After  free  catharsis — an  inordinate  quantity  of  medicine  being 
required  to  operate  upon  his  bowels — he  was  placed  upon  the 
use  of  sedatives.  Under  this  treatment  and  after  the  lapse 
of  two  days,  he  began  to  improve,  and  in  eight  days  he  left 
the  Asylum,  restored  to  his  ordinary  condition,  and  without 
much  of  the  torpor  that  existed  previously  to  his  excitement. 

The  general  term,  ill  health,  under  which  thirty-seven  cases 
are  arranged,  is  so  vague  and  indefinite,  and  it  may  include 
so  great  a  variety  of  diseases,  that  it  is  susceptible  of  but 
little  comment  of  special  application.  In  general  terms,  it 
may  be  supposed  that  almost  any  malady,  if  sufficiently  pro- 
longed, may  impair  the  vigor  of  the  body,  act  sympatheti- 
cally on  particular  organs,  diminish  the  quantity  or  derange 
the  action  of  the  nervous  fluid,  and  thus  disorder  the  mani- 
festations of  the  intellect. 

The  next  series  of  causes  are  those  which  are  arranged 
under  the  generic  term  fever.  Those  are  placed  first  whose 
predominant  pathological  effects  are  upon  the  circulatory  and 
nervous  systems  ;  and  those  which  follow  have,  as  a  leading 
feature,  disordered  action  of  the  liver. 

Pure  fever,  unallied  with  a  pathological  condition  of  either 
the  nerves  or  the  liver — if,  indeed,  such  a  disease  exist — may, 
from  the  rapidity  and  force  of  the  circulation,  impair  the 
functions  of  the  brain,  or,  it  may  produce  the  same  result 


93 

sympathetically,  through   the  inflammation  of  the  mucous 
membrane  of  the  alimentary  canal. 

If  the  disease  be  of  the  typhus  or  the  typhoid  form,  in 
which  the  nervous  system  becomes  most  seriously  involved, 
and  delirium  is  frequently  an  accompanying  symptom,  it  is 
easily  comprehended  that  mental  disorder  of  a  more  perma- 
nent character  may  ensue. 

It  is  probable  that  of  the  thirty-one  cases  included  under 
the  general  term  fever,  the  disease  in  many  or  most  of  them, 
was  of  one  of  the  specific  forms  afterwards  mentioned. 

In  the  bilious  fevers,  it  appears  to  us  that  the  disordered 
action  of  the  liver  is  the  primary  cause  of  insanity,  when 
this  disease  ensues.  Whether  the  disordered  action  of  the 
brain,  in  these  cases,  arise  from  sympathy  with  the  liver,  or  be 
produced  by  the  condition  of  the  blood — modified  as  that 
fluid  is,  in  its  constitution,  so  far  as  regards  the  elements  of 
the  bile — is  a  question  which  we  pretend  neither  to  explain 
nor  to  understand. 

Twenty-six  cases  are  said  to  have  arisen  from  dyspepsia. 
The  remarks  already  made  upon  this  disease  preclude  the 
necessity  of  any  farther  comment. 

Rheumatism  and  gout,  undoubtedly,  as  a  general  rule, 
cause  insanity  by  a  metastasis  to  the  dura-mater,  the  fibrous 
membrane  covering  the  brain. 

Phthisis  pulmonalis,  or  the  true  consumption,  is  not  unfre- 
quently  connected  with  insanity,  either  as  a  cause,  a  con- 
comitant, or  possibly,  in  some  instances,  an  effect.  In  the 
whole  range  of  human  maladies,  there  are  but  few  cases 
more  singular  or  interesting  than  those  in  which  these  two 
diseases  alternate  with  each  other  in  the  same  patient.  The 
consumptive  person  becoming  insane,  the  progress  of  the 
pulmonary  complaint  is  arrested  until  he  recovers  from  his 
mental  disorder,  when  it  resumes  its  march  until  stopped  by 
another  attack  of  mental  derangement,  again  to  progress,  if 


94 

that  malady  be  cured,  and  again  to  be  suspended  if  the  pa- 
tient should  become  insane.  This  singular  alternation  is 
probably  in  obedience  to  a  general  physiological  or  patho- 
logical law,  that  two  important  and  active  diseases  cannot 
simultaneously  exist  and  run  their  natural  course. 

The  deleterious  effects  of  the  sudden  suppression  of  a  natu- 
ral secretion,  or  an  accustomed  discharge,  whether  natural 
or  artificial,  are  well  known.  Habituated  to  a  constant 
drain,  the  body  is  brought  into  a  condition  in  which  that 
drain  appears  necessary  for  the  support  of  health.  If  it  be 
suspended,  the  system  becomes  plethoric,  or  laden  with  mat- 
ter unqualified  to  assist  in  the  action  of  the  different  organs, 
and  therefore  an  obstacle  to  the  faithful  performance  of  that 
action.  The  brain,  in  common  with  other  organs,  is  affected, 
and  consequently  the  manifestations  of  the  mind  disordered. 

Some  of  the  eruptive  fevers,  particularly  measles  and 
scarlatina,  are  proverbial  for  the  physical  defects  which  fol- 
low in  their  train.  Their  results  being  thus  unfavorable  to 
the  perfection  of  the  body,  it  is  not  remarkable  that  they 
should,  in  some  instances,  disorder  the  action  of  the  intellect. 
In  the  foregoing  list,  thirteen  cases  are  imputed  to  them. 

That  mysterious  and  peculiar  influence  of  the  salts  of  lead, 
which,  in  some  cases,  produces  colica  pictonum,  a  disease  so 
common  among  painters  as  to  have  derived  its  name  from 
them,  is  undoubtedly  the  same  which,  in  other  cases,  among 
people  who  are  accustomed  to  work  in  those  substances, 
originates  insanity. 

The  case  attributed  to  the  inhalation  of  prussic  acid,  is 
that  of  a  man  engaged  in  the  manufacture  of  fancy  soap. 
If  that  acid  were  truly  the  producing  cause  of  the  disease, 
it  may  be  supposed  to  have  effected  that  result  by  the 
depression  of  the  nervous  power,  its  natural  physiological 
effect. 

The  last  ten  items  in  the  table  of  physical  causes  con- 


95 

stitute  a  series  of  influences  to  which  the  female  sex  alone 
is  liable.  We  have  long  held  the  opinion  that  in  their  sex, 
these  are  the  predominating  causes  of  mental  alienation — 
an  opinion  corroborated  by  these  statistics.  It  will  be  per- 
ceived that  of  two  hundred  and  eighty-five  cases  of  females 
whose  disease  is  attributed  to  physical  causes,  no  less  than 
one  hundred  and  fifty-five  are  arranged  in  the  series  in  ques- 
tion. The  nervous  system  being  more  fully  developed,  at 
least  so  far  as  intensity  of  action  is  concerned,  in  females 
than  in  males,  and  the  intimacy  between  the  uterus  and  the 
other  organs  of  the  body  being  so  intimate,  so  powerful  and 
so  controling  as  the  observation  of  physicians  shows  it  to  be, 
there  is  little  reason  for  marvel,  that  the  causes  in  question 
should  be  so  prolific  of  mental  alienation.  Dr.  Rush  appears 
to  have  correctly  estimated  the  potency  of  these  causes,  and 
alleged  the  fact  as  an  argument  in  support  of  the  doctrine 
that  women  are  more  subject  to  insanity  than  men. 

Connected,  as  this  Asylum  is,  with  a  city  almost  purely 
commercial — a  city,  the  majority  of  whose  active  adults  are 
subject  to  the  cares,  the  perplexities  and  the  fluctuations  of 
trade,  it  is  not  remarkable  that,  among  moral  causes,  pecu- 
niary difliculties  should  occupy  the  most  prominent  position. 
Under  this  head  there  are  one  hundred  and  eighteen  men, 
and  fifteen  women,  a  total  of  one  hundred  and  thirty-three  ; 
and  if,  as  may  be  most  proper,  the  eleven  cases  assigned  to 
"  the  want  of  employment"  be  included,  the  total  will  be  one 
hundred  and  forty-four.  There  is,  perhaps,  no  mental  influ- 
ence which,  if  examined  in  all  its  bearings  and  relations, 
exercises  so  extensive  and  controling  a  power  upon  man  in 
civilized  countries,  and  more  particularly  in  the  United 
States,  as  that  arising  from  his  pecuniary  condition.  Con- 
nected with  this  are  many  if  not  all  his  hopes  and  schemes 
of  ambition,  preferment  and  aggrandisement — all  his  pros- 
pects of  present  and  future  temporal  comfort,  and  all  his 


96 

affections  that  are  enlisted  in  the  welfare  of  the  persons  con- 
stituting his  domestic  circle. 

A  constant  business,  moderate  in  extent  and  sufficiently 
lucrative  to  afford  a  liberal  subsistence,  can  never,  in  a  mind 
well  regulated,  operate  as  an  exciting  cause  of  mental 
disorder.  The  sources  of  the  evil  are,  on  the  one  hand, 
ambitious  views  and  endeavors  rapidly  to  accumulate  wealth, 
a^d,  on  the  other,  the  extremes  of  excessive  business, 
of  bankruptcy  and  of  poverty,  the  fluctuations  and  the  un- 
wholesome disposition  to  speculation.  Of  the  one  hundred 
and  eighteen  cases  of  men  r^rranged  under  the  head  of  pecu- 
niary difficulties,  the  disease  in  three  was  attributed  to  excess 
of  business  ;  in  two,  to  retiring  from  business  ;  in  four,  to  a 
sudden  access  of  fortune ;  in  one,  to  speculation  in  stocks, 
and  in  two,  to  speculation  in  the  moms  multicaulis. 

Moral  philosophy  requires  not,  for  its  illustration,  the 
assistance  of  the  fable  of  the  lion  and  the  gad-fly,  when  so 
harmless  and  apparently  impotent  a  vegetable  as  the  mul- 
berry can  overturn  the  faculties  of  the  human  mind. 

The  moral .  cause  which  ranks  next  in  point  of  numbers, 
among  both  the  men  and  women,  is  the  anxiety  and  other 
mental  influences  in  reference  to  religion.  The  whole  num- 
ber attributed  to  these  is  ninety-three ;  of  whom  fifty-one 
were  males,  and  forty-two  females.  Although  there  were 
more  men  than  women,  yet  the  proportionate  number,  when 
compared  with  the  whole  number  of  admissions,  is  greatest 
in  the  latter. 

In  a  country  of  universal  toleration  upon  religious  sub- 
jects, and  sheltering,  under  this  broad  banner,  congregations 
of  almost  every  sect  that  has  ever  appeared  in  Christendom, 
it  is  to  be  supposed  that  the  religious  sentiment  would  act 
under  its  greatest  possible  variety  of  phases,  and  in  every 
diversity  of  gradation  between  the  extremes  of  apathy  and 
fanaticism.     The  accurate  observer  of  the  events  of  the  last 


97 

twenty  years,  to  say  nothing  of  a  period  more  remote,  cannot 
fail  to  have  perceived  that  this  is  actually  the  fact.  Under 
these  circumstances,  and  when  we  consider  the  whole  scope 
and  bearing  of  this  sentiment,  both  temporal  and  eternal,  we 
cannot  but  perceive  how  important  an  influence  it  may 
exert.  It  is  difficult  to  believe  that  "  pure  religion  and  unde- 
filed"  should  overthrow  the  powers  of  the  mind  to  which  it 
was  intended  to  yield  the  composure  of  a  humble  hope  and 
the  stability  of  a  confiding  faith.  Nor  do  facts  authorize  any 
conclusion  thus  hostile  to  Christianity,  for  a  great  majority 
of  the  cases  of  insanity  attributed  to  religious  influence,  can 
be  traced  to  the  ardor  of  a  zeal  untempered  with  prudence, 
or  a  fanaticism  as  unlike  the  true  religion  which  it  professes 
as  a  grotesque  mask  is  to  the  face  which  it  conceals.  The 
exciting  doctrines  of  Miller,  the  self-styled  prophet  of  the 
immediate  destruction  of  the  world,  gained  but  little  hold  of 
the  public  mind  in  this  vicinity,  but  in  those  sections  of  the 
country  where  they  obtained  the  most  extensive  credence, 
the  institutions  for  the  insane  became  peopled  with  large 
numbers,  the  faculties  of  whose  minds  had  been  overthrown 
thereby. 

The  passions  or  emotions  whose  activity  tends  to  depress 
the  energies  of  both  body  and  mind,  may  be  considered,  on 
strictly  physiological  principles,  as  powerful  agents  in  the 
production  of  mental  disease. 

Remorse  is  the  first  of  these  mentioned  in  the  table,  and 
eleven  cases,  of  which  five  were  males  and  six  females,  are 
attributed  to  it. 

Grief  caused  by  the  death  of  relatives,  stands  next  in  posi- 
tion but  first  in  point  of  numbers,  including  as  it  does  forty- 
three  cases,  of  which  sixteen  were  males,  and  twenty-seven 
females.  Of  the  men,  the  particular  relatives  whose  death 
was  followed  by  so  unfortunate  an  occurrence,  is  stated  to 
have  been  the  wife  in  six  cases ;  the  wife  and  child  in  one  ; 


98 

the  wife  and  five  children  in  one  ;  the  child  in  three ;  the 
mother  in  two  ;  the  sister  in  one,  and  the  brother  in  two. 

Of  the  women,  it  was  the  husband  in  five  cases  ;  the  child 
in  eight ;  the  father  in  one  ;  the  mother  in  one  ;  the  mother 
and  child  in  one  :  the  mother  and  sister  in  one  ;  the  sister  in 
one ;  the  brother  in  two,  and  the  brother  and  sister  in  one. 

Forty  cases,  twelve  males  and  twenty- six  females,  are 
recorded  as  having  originated  from  disappointed  affection. 

Home-sickness,  or,  technically,  nostalgia,  is  assigned  as 
the  cause  in  three  cases — two  males  and  one  female. 
The  latter  was  a  Swiss  girl  who  had  been  but  a  short 
time  in  this  country,  and  could  not  speak  English.  Sepa- 
rated from  her  friends  and  surrounded  by  strangers,  her 
spirits  were  most  oppressively  borne  down  by  that  disease — 
if  disease  it  may  be  termed — so  proverbial  among  her  coun- 
trymen when  removed  from  the  sight  of  their  native  moun- 
tains and  valleys,  and  beyond  the  hearing  of  the  ranz  des 
vaches.  After  a  residence  of  a  few  weeks  at  the  Asylum,  a 
victim  at  once  to  the  delusions  of  insanity,  and  to  the  har- 
rowing emotions  from  which  that  disease  originated,  she 
ended  her  temporal  sufferings  by  suicide. 

Fear  is  at  all  times  a  depressing  emotion,  whether  it  be 
constant  and  prolonged,  or  sudden  and  transient,  as  more 
particularly  implied  by  the  term  fright.  In  the  latter  case  it 
is  powerfully  so,  even  to  the  production,  in  some  instances, 
of  immediate  death.  Its  natural  effect,  and  the  power  of  its 
action  particularly  qualify  it  as  a  source  of  mental  disturb- 
ance, and  hence  it  should  at  all  times,  if  possible,  be  avoided. 
The  tales  of  horror  conjured  up  to  amuse  or  to  subjugate 
children  in  the  nursery,  have  not  unfrcquently  been  attended 
with  the  most  deleterious  consequences ;  and  persons  who, 
for  amusement,  attempt  to  frighten  or  startle  their  friends, 
incur  the  risk  of  doing  the  latter  an  injury  beyond  their 
power  of  reparation. 


During  the  prevalence  of  an  epidemic,  the  fatality  of  the 
disease  is  greatly  augmented  by  the  panic  that  seizes  upon 
the  mass  of  the  community,  the  depressing  influence  of  which 
upon  the  energies,  both  physical  and  mental,  prepares  the 
way  for  an  easy  invasion  of  the  disorder.  This  influence  may 
also  affect  the  healthy  action  of  the  mind.  Thus,  of  the 
nineteen  cases  alleged  to  have  been  produced  by  this  general 
cause,  two  are  attributed  to  fear  of  the  Asiatic  cholera. 

With  students,  whether  young  or  of  middle  age,  if  a  pro- 
per equilibrium  be  maintained  between  the  physical  powers 
and  the  intellectual  faculties,  the  development  and  energies 
of  other  portions  of  the  body  being  so  promoted  and  sus- 
tained, by  exercise,  that  they  may  preserve  their  due  rela- 
tions with  an  enlarging  brain,  there  need  be  no  fear  that 
mental  alienation  will  result  from  application  to  study  ;  but 
unless  this  precaution  be  taken,  the  midnight  oil  consumed 
as  a  beacon  light  to  guide  towards  the  temple  of  truth,  may 
become  an  ignis  fatuus  leading  the  mind  into  the  labyrinth 
of  insanity.  Even  in  persons  of  strong  constitution  and  of 
great  physical  strength,  severe  and  prolonged  study  exhausts 
the  nervous  energy  and  impairs  the  functions  of  the  brain. 
How  much  greater  must  be  these  effects  in  a  frame  natural- 
ly delicate,  and  how  much  more  alarming  still,  if  the  body 
be  debilitated  by  the  want  of  exercise  ! 

In  the  table  of  causes,  thirty  cases  are  set  down  as  sup- 
posed to  have  been  induced  by  mental  application. 

Of  the  two  cases  placed  against  the  term  mental  shock,  one 
is  represented  to  have  been  produced  by  the  hearing  of  good 
news. 

Domestic  trouble  ranks  high  among  the  moral  causes.  It 
includes  forty-two  men,  and  twenty-three  women ;  a  total  of 
sixty-five. 

Under  the  general  and  somewhat  indefinite  term  anxiety, 
there  are  twenty-two  cases,  twelve  of  men,  and  ten  of  wo 


100 

men.  In  two  of  the  men,  the  anxiety  was  on  account  of  a 
false  accusation  of  seduction,  and  in  five  others  it  was  in 
reference  to  annoying  law-suits  in  which  they  were  en- 
gaged. 

Eight  cases  are  attributed  to  faulty  education  and  parental 
indulgence.  These  are  subjects  which,  during  the  past  few 
years,  have  been  fully  discussed  by  several  able  writers  on 
insanity,  and  hence  require  no  extended  comments  on  the 
present  occasion.  Although  sympathizing  deeply  in  the 
feelings  of  the  young,  and  entertaining  a  pleasing  and  affec- 
tionate emotion  for  all  that  cross  our  path  who  as  yet  tread 
but  the  vestibule  of  the  temple  of  life,  and  ardently  wishing 
to  promote,  by  every  judicious  measure,  their  welfare,  yet 
we  must,  and  even  for  those  very  reasons,  subscribe  to  the 
doctrine  of  the  prophet  of  olden  time,  "  It  is  good  for  a  man 
that  he  bear  the  yoke  in  his  youth."  Let  not  that  yoke,  how- 
ever, be  imposed  with  despotic  hands,  but  with  that  prudent 
combination  of  kindness  and  firmness  which  will  render  its 
burden  light. 

Three  cases  are  attributed  to  undue  indulgence  in  the 
reading  of  novels.  Inasmuch  as  this  subject  has  heretofore 
often  received,  and  undoubtedly  will  continue  to  receive  the 
attention  of  men  who  "  stand  in  wisdom's  sacred  stole,"  we 
dismiss  it  without  comment. 

There  are  several  heads  included  in  the  tables,  to  which 
especial  reference  has  not  been  made,  but  they  are  either  so 
unimportant  or  so  similar  to  others  which  have  been  noticed, 
that  they  do  not  appear  to  call  for  any  specific  remarks. 


101 


SECTION    IX. 


FORM     OF     DISEASE. 

The  particular  type  assumed  by  the  mental  disorder  of  the 
patients,  is  recorded  in  1721  cases.  These  are  arranged 
below. 


Mania, 

Mania,  partial, . . 

Mania,  paroxysmal, . . 
Mania,  paralytic,  . . . . 
Mania,  epileptic,  . . . . 
Mania,  cataleptic,  . . . 

Typhomania, 

Delirium  of  phrenitis. 

Nymphomania, 

Satyriasis,  .  - 

Monomania, 

Melancholia, 

Dementia, 

Imbecility, 

Idiocy, 

Moral  Insanity, 


Males. 

Females. 

Total. 

529 

376 

905 

6 

2 

8 

20 

9 

29 

20 

4 

24 

30 

5 

35 

2 

0 

2 

3 

1 

4 

4 

5 

9 

0 

C 

6 

2 

0 

2 

135 

97 

232 

99 

86 

185 

151 

84 

235 

11 

12 

23 

11 

3 

14 

6 

2 

8 

1029 

692 

1721 

Mania  occupies  the  first  rank  in  point  of  numbers,  in  either 
sex,  as  well  as  in  the  aggregate.  There  were  nine  hundred 
and  five  of  this  form  of  disease,  which  is  equivalent  to  ffty- 
two  and  one  half  per  cent  of  the  whole  number. 

The  second  in  rank  among  the  men,  and  in  the  total  of  the 
two  sexes,  is  Dementia.  Of  this,  there  were  two  hundred 
and  thirty- five  cases,  or  thirteen  and  sixty-jive  hundredths  per 
cent  of  the  whole. 

Monomania  occupies  the  third  position  in  the  men,  and  in 
the  total ;  but  the  second  in  women.  There  were  two  hun- 
dred and  thirty-two  cases,  or  thirteen  and  jifty-nine  hun- 
dredths per  cent. 

Melancholia  is  the  fourth  in  men,  and  in  the  total,  but  the 


third  in  the  women.  Of  this  there  were  one  hundred  and 
eighty-five  cases,  or  nearly  ten  and  three  quarters  per  cent. 

Epilepsy  holds  the  fifth  rank,  there  being  thirty-five  cases, 
or  two  and  three  hundredths  per  cent. 

The  numbers  of  the  remaining  forms  are  still  less,  and 
their  proportion  may  be  readily  ascertained  by  an  inspection 
of  the  table. 

The  nosology  of  mental  diseases  is  still  so  imperfect,  that 
it  is  difficult  to  make  an  arrangement  of  cases  which  would 
be  of  any  material  value,  either  practical  or  theoretical.  In- 
deed, there  are  scarcely  two  physicians  who  would  classify 
a  series  of  cases,  such  as  are  admitted  into  any  institution,  in 
precisely  the  same  manner.  The  forms  of  disease,  in  the 
cases  included  in  the  foregoing  table,  were  recorded,  in  part, 
by  several  physicians,  whose  views  upon  the  subject  may 
have  differed,  and  hence  the  classification  is  undoubtedly 
different  from  what  it  would  have  been,  had  it  been  made 
entirely  by  one.  A  case  called  Partial  Insanity  by  one  per- 
son, might  be  termed  Monomania  by  another.  That  which 
one  records  as  Monomania,  another  would  place  under  the 
head  of  Melancholia.  There  being  no  definite  line  between 
Mania  and  Dementia,  a  given  case  might  be  placed  under 
the  former  by  one  physician,  and  under  the  latter  by 
another. 

A  perfect  nomenclature  of  Insanity  is  a  great  desideratum. 


103 


SECTION    X. 
PREVIOUS     ATTACKS     OF     INSANITY. 

Many  cases,  particularly  in  the  early  period  of  this  estab- 
lishment, when  there  were  but  few  institutions  in  the  coun- 
try, were  not  removed  to  any  asylum  at  the  time  of  first 
attack.  Some  others,  although  at  another  institution  dur- 
ing their  first  attack,  were  admitted  here  on  some  subsequent 
invasion  of  the  disease.  All  the  cases  recorded  as  having 
had  previous  attacks,  are  included  in  the  following  table  : — 

Males.        Females.        Total. 

One  previous  attack. 
Two  previous  attacks, 
Three  previous  attacks, 
Four  previous  attacks 
Five  previous  attacks. 
Nine  previous  attacks, 
Several  attacks, 
Many  attacks,     . 

Total,  .         .         .         110         98       208 

Thus,  two  hundred  and  eight  patients  were  known  to  have 
previously  suffered  from  the  disorder.  This  is  equivalent  to 
eleven  and  twenty-nine  hundredtJis  per  cent  of  the  whole  num- 
ber admitted.  The  per  centage  of  men  is  a  small  fraction 
more  than  ten.     That  of  women,  a  little  more  than  thirteen. 


74 

56 

130 

15 

14 

29 

5 

5 

10 

3 

0 

3 

1 

0 

1 

.       0 

1 

1 

10 

16 

26 

.       2 

6 

8 

104 

SECTION    XI. 
OF     THE     SUICIDAL     PROPENSITY. 

Among  the  insane  of  either  sex,  at  all  times  and  in  all 
countries,  there  is  a  number,  not  inconsiderable,  who  labor 
under  a  propensity  to  self-destruction.  So  far  as  the  records 
of  the  cases  admitted  into  this  institution  furnish  information 
upon  this  subject,  the  following  table  gives  the  number  in 
whom  this  disposition  appeared.  They  are  arranged  ac- 
cording to  the  terms  used  in  the  history  of  their  cases. 

Attempted  to  commit  suicide. 
Made  two  attempts  to  commit  suicide, 
Made  three  attempts  to  commit  suicide. 
Made  several  attempts  to  commit  suicide, 
Threatens  to  commit  suicide, 
Disposed  to  commit  suicide. 
Talks  of  committing  suicide, 
Committed  suicide  at  the  Asylum,     . 

Hence  it  appears  that  fifty-seven  men  and  fifty-two  wo- 
men, a  total  of  one  hundred  and  nine,  had  actually  attempted 
to  destroy  themselves.  The  number  who  had  attempted  to 
do  it  more  than  once  was  thirty-eight,  of  whom  nineteen 
were  men  and  nineteen  women. 

Of  the  thirty-eight  men  included  under  the  term  attempted 
suicide,  in  the  first  line  of  the  foregoing  table,  the  records 
state  that  the  attempt  was  made  to  cut  the  throat  by  seven ; 
with  a  knife,  by  one  ;  to  drown,  by  six ;  with  laudanum,  [by 
two ;  to  leap  from  a  window,  by  three ;  to  hang,  and  to 
strangle,  each  by  one.  In  the  others,  the  particular  method 
is  not  mentioned. 

Of  the  men  said  to  have  made  two  attempts,  one  en- 
deavored to  shoot  himself,  and  another  took  two  ounces  of 
laudanum. 


^ales. 

Females. 

Total. 

38 

33 

71 

3 

3 

6 

1 

1 

2 

15 

15 

30 

5 

4 

9 

7 

8 

15 

2 

1 

3 

1 

7 

8 

105 

The  man  who  made  three  attempts,  first  took  laudanum, 
next  endeavored  to  cut  his  throat,  and  lastly  attempted  to 
shoot  himself. 

Of  those  who  made  several  attempts,  it  is  stated  that  one 
endeavored  to  drown  himself  once,  and  another,  twice. 

Of  the  thirty-three  women  in  the  first  line,  the  method  re- 
sorted to  in  the  endeavor  to  take  their  lives,  so  far  as  infor- 
mation is  given,  was  as  follows : — One  with  a  razor,  one 
with  a  knife,  one  by  cutting  the  throat,  one  by  strangulation, 
one  by  hanging,  two  by  drowning  and  one  with  laudanum. 

Of  the  women  who  made  two  attempts,  one  endeavored 
to  drown,  and  afterwards  to  strangle  herself;  another  at- 
tempted to  drown,  and  afterwards  to  destroy  herself  with  a 
knife  ;  the  third  took  laudanum,  and  subsequently  endeavored 
to  hang  herself. 

The  three  attempts  of  a  woman  recorded  in  the  third  line 
were,  first  with  a  cutting  instrument,  second  to  hang  herself, 
and  third  to  leap  from  a  window. 

Of  the  women  who  made  several  attempts,  one  attempt  of 
one  of  them  was  to  poison  herself  with  arsenic.  Two  at- 
tempts of  another  were  by  the  means  of  laudanum  and 
drowning ;  and,  of  two  others,  each  made  one  attempt  to 
drown  herself. 

Such  persons  as  are  intimately  acquainted  with  the  insane 
will  recognise  an  important  difference  between  the  terms  dis- 
posed to,  on  the  one  hand,  and,  on  the  other,  talks  of,  or  threat- 
ens to  commit  suicide.  Patients  in  whom  the  propensity  to 
self-destruction  is  the  strongest,  and  who  are  most  likely  to 
be  urged  onwards  by  it  to  a  fatal  execution  of  their  designs, 
never,  or  rarely,  in  any  manner  allude  to  that  propensity,  but, 
on  the  contrary,  use  every  precautionary  measure  to  conceal 
it.  I  have  never  known  but  one  person  accustomed  to  talk 
of  the  propensity,  who  afterwards  committed  suicide.  This 
7 


106 

was  a  woman  whose  case  offers  an  exception  not  only  to 
this,  but  to  another  general  rule.  The  suicidal  rarely — so 
very  rarely  that,  it  might  almost  be  said  never — put  their 
intentions  into  execution  in  the  presence  of  another  person. 
This  patient  hung  herself  within  five  feet  of  another  female, 
a  fellow-patient,  who,  however,  it  is  possible  she  supposed 
to  have  been  sleeping,  as  the  act  was  committed  in  the 
night. 

Patients  who  threaten  to  commit  suicide,  almost  invariably 
do  so  for  the  purpose  of  frightening  the  people  around  them, 
rather  than  from  any  propensity  in  that  direction.  I  do  not 
recollect  ever  to  have  met  with  a  single  exception  to  this. 

One  of  the  most  remarkable  characteristics  of  the  really 
suicidal,  is  their  fearfulness  of  being  injured  by  others.  A 
man  will  shrink  from  those  by  whom  he  is  surrounded,  lest 
they  should  do  him  harm,  in  the  slightest  degree,  and  the 
next  moment  take  his  life  with  his  own  hand. 


Males. 

Females. 

Total. 

5 

0 

5 

13 

7 

20 

11 

6 

17 

0 

1 

1 

0 

1 

1 

107 

SECTION    XII. 
THE     HOMICIDAL     PROPENSITY. 

The  number  of  patients  in  whom  the  homicidal  propensity 
existed,  or  had  been  known  previously  to  exist,  and  the  ex- 
tent to  which  that  propensity  had  influenced  their  conduct, 
will  be  perceived  by  the  subjoined  table. 

Had  committed  murder, 

Had  attempted  to  kill, 

Threatened  to  kill, 

Attacked  a  daughter  while  asleep, 

Thinks  it  her  duty  to  kill  some  one, 

Of  the  five  actual  homicides,  one  killed  a  child  ;  one,  his 
mother-in-law  ;  and  one,  his  wife's  brother.  Of  the  remain- 
ing two,  it  is  merely  stated  that  one  killed  a  person  ;  and  the 
other  killed  a  man  with  a  knife,  was  tried  and  acquitted  on 
the  ground  of  insanity. 

Of  the  m.en  who  attempted  to  kill,  that  attempt  was  made 
on  a  wife  by  five  ;  on  a  wife  and  child,  by  one  ;  on  a  father, 
by  two  ;  on  a  brother,  by  one  ;  on  a  sister,  by  one  ;  and  on  a 
constable,  by  two. 

Of  the  men  who  threatened  to  kill,  the  threat  v/as  against 
a  wife  in  two  cases,  his  friends  in  eight,  and  his  family  in  one. 

The  attempt  to  kill,  by  women,  were  in  five  cases  upon  a 
child,  in  one  case  upon  a  sister,  and  in  one  upon  a  sister  and 
step-mother. 

The  threats  to  kill,  by  women,  were  against  a  husband  in 
two  cases,  against  her  children  in  one,  her  friends  in  one,  and 
in  one  the  particular  persons  are  not  mentioned. 

It  may  be  observed  that  many  of  the  insane,  particularly 
when  excited,  threaten  to  kill  those  around  them,  without  any 
intention,  certainly  any  permanent  intention  to  put  their 
threats  into  execution. 


108 


SECTION     XIII. 
CONDITION  OF  THE    PATIENTS  WHEN  DISCHARGED  FROM    THE    ASYLUM. 

The  table  subjoined  exhibits  the  condition  of  the  patients 
at  the  time  of  discharge,  and  the  number  still  remaining  in 
the  Asylum. 

Males.  Females.  Total. 

Cured, 408  264  672 

Much  improved,    ....  58  46  104 

Improved,           .         .         .         .  176  142  318 

Relieved,       .         •         .         .         .  6  1  7 

Unimproved,     ....  2  1  3 
Discharged  by  request  of  friends, 

mostly  unimproved,        .         .  222  179  401 

Eloped,  condition  not  stated,      .  ^6  4  30 

Died, 148  79  227 

Whole  number  discharged,      .         1040         716       1762 
Remain, 44  35  79 

Whole  number  admitted,  .         1090         751       1841 

One  thousand  seven  hundred  and  sixty-two  patients  were 
discharged,  of  whom  one  thousand  and  forty-six  were  men, 
and  seven  hundred  and  sixteen  women.  Of  these,  four  hun- 
dred and  eight  men  and  two  hundred  and  sixty-four  woinen 
were  cured,  making  a  total  of  six  hundred  and  seventy-two. 

There  were  forty-two  of  the  foregoing  patients — twenty- 
three  men  and  nineteen  women — who,  after  a  short  residence 
in  the  Institution,  were  discharged  as  follows  : — 

Much  improved,         .......     9 

Improved,        ........       16 

Relieved,    .........     1 

Discharged  by  request  of  friends,  .         .         .         .14 

Eloped, .         .         .2 

btit,  after  a  brief  absence,  were  re-admitted,  and  finally  dis- 
charged cured.  These  cases  should  be  added  to  the  cures 
in  the  former  table. 


109 

It  is  now  (August,  1847,)  upwards  of  two  years  and  a  half 
since  the  close  of  the  period  embraced  by  these  statistics.  At 
that  time,  as  will  be  perceived  by  the  table,  there  remained 
in  the  Institution  seventy-nine  patients,  who  were  here  on 
their  first  admission.  A  large  proportion  of  these  were  old, 
incurable  cases,  which  had  been  in  the  Asylum  for  many 
years. 

A  sufficient  time  has  now  elapsed  to  test  the  curability  of 
the  few  whose  disease  was  of  a  more  recent  date.  The  sub- 
joined list  exhibits  the  present  condition  of  the  seventy-nine 
patients  in  question  : — 

Males.         Females.  Total. 

Discharged  cured,       ...         4  6  10 


(> 

much  improved,  . 

.     0 

3 

3 

« 

improved, 

8 

3 

11 

a 

unimproved, 

.     7 

8 

15 

Died,  . 

. 

4 

3 

7 

Remain 

ing,  all  incurable, 

.  21 

12 

33 

The  results  in  this  table  should  also  be  added  to  the  fore- 
going. 

It  is  not  unfrequently  the  case,  that  a  patient  who  is  pro- 
gressing towards  recovery,  is,  through  the  anxiety  of  friends, 
prematurely  removed,  before  a  cure  has  been  established. 
Eighteen  cases  of  this  kind,  of  which  thirteen  were  dis- 
charged much  improved,  four  improved,  and  one  by  the 
request  of  friends,  the  condition  not  stated,  are  known  to 
have  recovered  soon  after  leaving. 

Our  object  being  to  ascertain,  as  nearly  as  possible,  the 
curability  of  Insanity,  it  is  very  apparent  that  these  cures, 
also,  should  be  included  in  the  original  list.  Indeed,  it 
is  but  justice  to  the  Institution  that  they  should  be  included, 
inasmuch  as,  if  they  were  cured  by  any  system  of  treatment, 
it  was  that  which  was  pursued  here. 


110 

After  these  explanations,  it  appears  that  the  cures  were  as 
follows : — 

Males. 

Discharged  cured  previously  to  Dec. 

31st,  1844,         ...         408 
"  cured  subsequently,     .         4 

"  not  cured  on  first  admis- 

sion, but  cured  on  re-admission,  23 
Known  to  have  recovered  after  discharge,  6 


Females. 

Total. 

264 

672 

6 

10 

19 

42 

12 

18 

Aggregate,         .         441         301       742 

All  the  foregoing  cases  which  remain  in  the  Institution 
are  believed  to  be  incurable,  and  as  those  who  were  dis- 
charged not  cured  have  become  widely  scattered,  and  mostly 
lost  sight  of,  it  is  probable  that  this  table  exhibits  all,  or  very 
nearly  all,  whom  we  shall  ever  ascertain  to  have  been  cured. 
This  makes  the  per  cent,  of  cures  of  both  sexes  40  and  30-100. 
Of  the  men  it  was  40  and  46-100;  of  the  women  40  and 
8-100. 

Some  authors  believe  that,  of  the  insane,  females  are 
more  curable  than  males.  In  these  cases,  however,  the  com- 
parative curability  of  the  two  sexes  is  somewhat  in  favor  of 
the  men. 

We  must  not  leave  this  subject,  without  referring  to  a 
cause  which  has  operated  unfavorably  upon  the  curability 
of  the  patients,  taken  as  a  whole,  that  have  been  received 
into  this  Institution,  When  the  Asylum  was  first  opened, 
fifty-two  were  transferred  to  it  from  the  old  establishment. 
A  great  majority  of  these  were  chronic  and  incurable  cases, 
which  had  been  accumulating  there  for  many  years.  This 
fact  will  become  evident  if  illustrated  by  their  history  sub- 
sequently to  admission  into  this  Institution,  which  is  as  fol- 
lows : — 


Males. 

Females. 

Total. 

32 

20 

52 

4 

0 

4 

.     1 

0 

1 

2 

3 

5 

17 

10 

27 

0 

1 

1 

•     2 

3 

5 

.       6 

3 

9 

32 

20 

52 

111 


The  whole  number  was, 

Discharged  cured, 

"  much  improved,   . 

"  improved, 

"  by  request  of  friends, 

mostly  unimproved. 
Eloped,  condition  not  stated,     . 

Died, 

Remaining,  Dec.  31st,  1844, 

Total, 

Thus  it  appears  that  only  four  of  these  cases  were  cured. 
This  is  equivalent  to  but  7  and  7-10  per  cent. 

The  condition  of  the  patients  who  were  received  from  the 
N.  Y.  Almshouse,  was  very  similar  to  those  who  were  brought 
from  the  old  Asylum.  In  the  repeated  transfers  of  patients 
which  took  place  between  the  Almshouse  and  this  Institu- 
tution,  several  were  brought  here  more  than  once.  The 
whole  number  of  first  admissions  was  sixty-six,  of  whom 
twenty-nine  were  men,  and  thirty-seven  women.  Of  these, 
only  four  men  and  twelve  women,  a  total  of  sixteen,  were 
cured ;  and  of  all  that  were  re-admitted,  a  recovery  did  not 
take  place  in  a  single  case.     Hence  we  have — 

Males. 

Admitted  from  the  old  Asylum       .     32 
Admitted  from  the  N.  Y.  Almshouse,  29 


Females. 

Total, 

20 

52 

37 

66 

57 

118 

12 

20 

Total,  .         .         .         61 

Of  all  these  there  were  cured  but  .       8 

Subtracting  these  cases  from  the  whole  number  of  admis- 
sions, and  their  cures  from  the  whole  number  of  cures. 

We  have  the  per  cent,  of  cures  in  men,     .     42  and    8-100 
Do.  women,      41  and  64-100 

Do.  both  sexes,  4 1  and  90-100 


112 


SECTION    XIV. 

TERM      OF      RESIDENCE      IN     THE     ASYLUM      OP      THE 
PATIENTS     WHO     WERE     CURED. 

Physicians  to  Institutions  for  the  Insane  are  frequently 
questioned  in  reference  to  the  time  necessary  to  effect  a  re- 
storation, in  cases  of  insanity.  The  following  table  shows 
the  term  of  residence  in  the  Asylum,  of  all  the  patients  who 
were  discharged  cured  on  their  first  admission : — 

Less  than  one  month. 
From  one  to  two  months, 
From  two  to  three  months, 
From  three  to  four  months,     . 
From  four  to  five  months,    . 
From  five  to  six  months. 
From  six  to  seven  months,  . 
From  seven  to  eight  months,  . 
From  eight  to  nine  months, 
From  nine  to  ten  months, 
From  ten  to  eleven  months. 
From  eleven  to  twelve  months. 
From  one  to  tw^o  years. 
Upwards  of  two  years,   . 

The  Avhole  number  who  were  in  the  Asylum  less  than 
three  months  each,  is  two  hundred  and  ninety-six.  This  is 
equivalent  to  forty-four  in  every  hundred  that  were  cured. 
The  whole  number  from  three  to  six  months  is  two  hundred 
and  one,  or  thirty  in  every  hundred.  The  whole  number 
from  six  to  twelve  months  is  one  hundred  and  twenty-seven, 
nearly  nineteen  in  every  hundred. 

The  whole  number  who  were  here  upwards  of  one  year 
each  is  forty-eight,  or  seven  in  every  hundred. 

The  mean  or  average  term  of  residence  in  the  Asylum 
was,  for  the  men,  four  months  and  twenty-seven  days ;  and 
for  the  women,  five  months  and  twenty-six  days. 


Males. 

Females. 

Total 

45 

31 

76 

.     76 

37 

113 

66 

41 

107 

.     61 

41 

102 

29 

25 

54 

.     25 

20 

45 

29 

17 

46 

.     10 

12 

22 

8 

6 

14 

.     13 

5 

18 

5 

7 

12 

.     11 

4 

15 

23 

12 

35 

.       7 

6 

13 

113 

Setting  aside  the  thirteen  cases  in  which  the  persons  were 
here  more  than  two  years  each,  the  average  time  will  be,  for 
men,  four  months  and  ten  days,  and,  for  women,  four  months 
and  twenty-five  days. 

The  mean  or  average  time  of  residence  of  both  sexes,  in- 
clusive, is  five  months  and  eight  days.  Excluding  the  thir- 
teen cases  before  mentioned,  it  is  four  months  and  sixteen 
days. 

Many  people  who  take  their  friends  to  an  institution  of 
this  kind,  appear  to  be  impressed  with  the  idea  that,  if  a 
restoration  be  possible,  it  can  be  effected  in  a  few  days,  as 
in  an  ordinary  fever.  But  insanity,  particularly  in  those 
cases  which  are  sufficiently  prolonged  to  induce  their  friends 
to  remove  them  to  an  Asylum,  is  essentially  a  chronic  dis- 
ease, and,  even  under  the  most  skilful  management,  requires 
a  considerable  time  for  its  removal,  and  the  establishment  of 
mental  health.  Were  it  possible  always  to  induce  the  friends 
and  guardians  of  patients  to  leave  them  at  the  Asylum  a 
sufficient  time,  fully  and  satisfactorily  to  test  their  curability 
by  the  restorative  means  here  employed,  the  recoveries 
would  undoubtedly  be  augmented,  and  that  to  no  small 
extent.  At  the  Retreat,  near  York,  England,  where  every 
patient  is  retained,  if  not  cured,  until  all  curative  resources 
are  exhausted,  it  is  stated,  by  the  officers  of  that  institution, 
that  thirty-five  per  cent,  of  all  the  recoveries  do  not  take 
place  until  the  patients  have  been  in  the  Asylum  more  than 
a  year. 


114 


SECTION    XV. 
CURABILITYAS    CONNECTED    WITH    AGE. 

It  has  generally  been  believed  that,  other  things  being 
equal,  the  curability  of  the  insane  is  in  a  proportion  inversely 
to  their  ages ;  or,  the  younger  the  patient  the  greater  the  pros- 
pect of  restoration.  This  belief  was  undoubtedly  founded,  as 
reasonably  it  might  have  been,  upon  the  fact  of  the  stronger 
constitution  and  the  unexhausted  physical  energies  of  per- 
sons in  the  early  stages  of  manhood. 

More  recently  there  has  been  a  tendency,  in  some  quarters, 
to  the  opposite  opinion — that  the  disease  is  more  curable  in  ad- 
vanced life.  The  subjoined  table  exhibits  the  ages,  so  far  as 
known,  on  admission,  of  the  six  hundred  and  seventy  two 
patients  who  were  cured  at  the  time  they  were  first  dis- 
charged from  the  Asylum. 

Under  twenty  years, 
From  twenty  to  thirty  years, 
From  thirty  to  forty  years. 
From  forty  to  fifty  years. 
From  fifty  to  sixty  years. 
From  sixty  to  seventy  years. 
From  seventy  to  eighty  years,    - 
From  eighty  to  ninety  years. 

Total,     391       249       640 

By  far  the  largest  number  of  cures  was  in  persons  be- 
tween twenty  and  thirty  years  of  age.  It  will,  however,  be 
recollected  that  the  number  of  patients  who,  at  the  time  of 
admission,  were  between  twenty  and  thirty,  very  much  ex- 
ceeded that  of  those  who  were  in  any  other  decennium  of  life- 
Consequently,  although  the  actual  number  of  cures  at  that 
age  greatly  predominates,  it  does  not  necessarily  follow  that 
a  larger  proportion  recovered  than  in  some  of  the  other 
periods. 


Males. 

Females. 

Total. 

30 

30 

GO 

158 

113 

271 

107 

55 

162 

57 

29 

86 

25 

19 

44 

11 

2 

13 

3 

0 

3 

0 

1 

1 

115 

The  following  table  exhibits,  for  either  sex  separately,  and 
for  the  total  of  both  sexes,  the  per  eentage  of  cures  m  each 
period,  calculated  upon  the  number  of  admissions  m  that 

^  '  Males.       Females.         Total. 

46  16     58.82     51.72 
Under  twenty  years,        .        •         ^"-  ^^^^ 

From  twenty  to  thirty  years,         .     44.00     42.17     4d.^^ 

^^'^^rrCfiKarr        •  •         :'!  25.60     Its, 

From  forty  to  titty  years,      .  or  7-?  28  78     28.10 

From  fifty  to  sixty  years,          •  f-'-^  ^-         ^^^^ 

From  sixty  to  seventy  years  .  .     2J.7^  1  • 

From  seventy  to  eighty  years,   .  17.64  OO.UU 

From  eighty  to  ninety  years,  .     00.00  50.uu 

Of  the  whole  number  of  patients  of  different  ages,  the  pro- 
portion  of  cures  was  greatest  in  those  who  were  under  twenty; 
and  that  proportion  diminishes,  progressively  -d  regularly 
through  all  the   subsequent  decades  of  human  life,  as  far 
as  the  eightieth  year.    There  were  but  three  patients  above 
eighty  years  of  age,  and  one  of  them  was  cured.     This  is 
equivalent  to  thirty-three  and  one-third  per   cent,  but  the 
number  is  so  small  as  to  be  of  no  value  in  establishing  the  pro- 
portion of  cures  at  that  period  of  life,  and  altogether  insuffi- 
cient to  unsettle  the  general  rule  apparent  in  the  other  cases, 
of  diminishing  curability  in  the  advancing  stages  of  hte. 

If  the  subject  be  investigated  in  regard  to  the  sexes  sepa- 
rately, it  will  be  found  that  the  greatest  proportion  of  cures 
was  under  twenty  years  of  age,  and  that  t^^^-^^^^^^^^ 
minution  of  that  proportion  in  the  higher  decades  of  life,  holds 
crood,  with  but  a  single  exception,  in  either  sex. 
"  Of  the  men,  about  one  per  cent  more  were  cured  m  the  age 
from  sixty  to  seventy  years  than  in  that  from  fifty  to  sixty ; 
and  in  the  women,  the  cures  between  fifty  and  sixty  years 
were  somewhat  more  than  three  per  cent  greater  than  those 
between  forty  and  fifty.  .„„«,r« 

The  proportion  of  cures  among  women  under  twenty  years 


116 

of  age  was  more  than  twelve  and  a  half  per  cent  greater 
than  that  of  men  ;  but  in  all  the  other  periods,  the  proportion 
of  men  predominated  over  that  of  women,  with  the  excep- 
tion of  the  period  from  fifty  to  sixty  years,  when  there  was 
but  very  little  difference  in  the  two  sexes. 

The  decennium  from  eighty  to  ninety,  being  so  palpably 
exceptionable,  is  not  taken  into  account. 

Hence,  the  old  doctrine  that  mental  alienation  is  more  cu- 
rable in  early  life  than  at  more  advanced  periods,  is  strongly 
supported  by  these  statistics. 


117 


SECTION  xvr. 

ELOPEMENTS. 

The  thirty  cases  recorded  as  eloped,  in  the  table  of  Con- 
dition at  time  of  Discharge,  are  such  alone  as  were  so  dis- 
charged upon  the  register,  without  any  statement  of  the  con- 
dition of  the  patient  at  the  time  of  leaving  the  Asylum. 
Whenever  that  condition  vi^as  specified,  the  case  was  placed 
under  its  appropriate  head,  without  reference  to  the  elope- 
ment.    The  aggregate  of  these  is  as  follows : 


Eloped  cured,  and  placed  under  the  head  cured. 

Eloped  much  improved,  and  under  the  head  much  improved, 

Eloped  improved,  and  placed  under  the  head  improved, 

Total,        23     6     29 

Of  the    1841    patients,   forty-nine  men  and  ten  women,  a 
total  of  fifty  nine  eloped  upon  their  first  admission. 


M. 

F. 

T. 

12 

3 

15 

4 

3 

7 

7 

0 

7 

It  will  be  seen  that  the  number  of  deaths,  on  first  admis- 
sion, was  two  hundred  and  twenty-seven,  of  which  one  hun- 
dred and  forty-eight  were  of  males  and  seventy-nine  of 
females.  This  is  equivalent  to  twelve  and  thirty-three  hun- 
dredths per  cent  of  the  whole  number,  or  an  annual  per  cent 
of  eleven  and  five  hundredths.  The  further  consideration  of 
this  subject  will  be  resumed  in  a  succeeding  section. 


118 


SECTION    XVII. 
TIME     OF     RESIDENCE     IN     THE     ASYLUM. 

The  following  table  shows  the  time  of  residence  in  the 
Asylum  of  the  1762  cases  of  first  admission  discharged  pre- 
viously to  December  31st,  1844. 


Time. 

M. 

F. 

T. 

Time. 

M. 

P. 

T. 

Time. 

M. 

F. 

T. 

Iday 

0 

0 

0 

1  month 

74 

53 

127 

1  year 

15 

10 

25 

2  days 

3 

2 

5 

l^months 

73 

51 

124 

1  yr  1  mo 

17 

15 

32 

3  days 

2 

1 

3 

2  months 

68 

44 

112 

1  yr  2  mo 

10 

14 

24 

4  days 

1 

2 

3 

2|^months 

63 

38 

101 

1  yr  3  mo 

18 

7 

25 

5 days      2 

0 

2 

3  months 

95 

65 

160 

1   yr  6  mo 

15 

10 

25 

6  days 

5 

1 

6 

Sjmonths 

40 

22 

62 

1  yr  9  mo 

12 

8 

20 

7  days 

13 

7 

20 

4  months 

40 

33 

73 

2    years 

27 

17 

44 

8  days 

7 

2      9 

4^months 

23 

21 

44 

2  J  years 

14 

7 

21 

9days 

9 

2 

11 

5  months 

23 

24 

47 

3    years 

7 

8 

15 

10  days 

9 

4 

13 

5jmonths 

28 

17 

45 

3^  years 

6 

6 

11 

1 1  days 

8 

6 

14 

6  months 

46 

25 

71 

4    years 

14 

18 

32 

12 days 

3 

3 

6 

6^months 

26 

15 

41 

5    years 

7 

6 

13 

13 days 

4 

3 

7 

7  months 

14 

14 

28 

6    years 

4 

0 

4 

14days 

11 

5 

16 

7^months 

14 

9 

23 

7    years 

6 

5 

11 

15days 

5 

2 

7 

8  months 

11 

12 

23 

8    years 

3 

0 

3 

1 6  days 

6 

3 

9 

Sjmonths 

13 

7 

20 

9    years 

1 

2 

3 

ITdays 

1 

2 

3 

9  months 

14 

11 

25 

10    years 

2 

1        3 

18  days 

3 

6 

9 

9^  months 

15 

7 

22 

1 1    years 

3 

0        3 

19 days 

2 

1 

3 

10  months 

4 

4 

8 

12    years 

1 

1        2 

20 days 

6 

0 

6 

lOimonths 

10 

5 

15 

13    years 

0 

3        3 

21 days 

12 

5 

17 

11  months 

3 

6 

9 

16    years 

2 

0        2 

22 days 

6 
4 

8 
2 

14 
6 

11  ^months 

12 

8 

20 

18    years 

1 

Q        1 

23days 

709 

491 

1200 

More  than 

i 

24days 

6 

3 

9 

1  year 

185 

137,  322 

25 days 

4 

3 

7 

From  Imo 

1 

26days 

7 

4 

11 

to  1  yr 

709 

491  1200 

27 days 

2 

1 

3 

Under 

28 days 
29days 

6 

7 

13 

1  month 

152 

88 

240 

5 

3 

8 

10461716 

1762 

152 

8S 

240 

119 

Two  hundred  and  forty  patients  left  the  Asylum  before  the 
expiration  of  a  month  from  the  time  of  their  admission  ;  one 
hundred  and  fifteen  were  here  less  than  two  months  each, 
and  of  these,  thirty-nine  were  here  but  from  two  to  seven 
days  each. 

The  number  from  one  to  three  months  was  six  hundred 
and  twenty-one ;  from  three  to  six  months,  three  hundred 
and  forty-two ;  from  six  to  nine  months,  one  hundred  and 
sixty  ;  from  nine  to  twelve  months,  ninety-nine. 

The  number  who  were  here  for  a  longer  period  than  one 
year  each,  may  readily  be  seen  by  an  inspection  of  the 
table. 

The  mean  or  average  time  of  residence  of  the  whole  was 
nine  months  and  nineteen  days  ;  for  the  men,  nine  months 
and  twelve  days,  and  for  the  women,  ten  months. 


Males. 

Females. 

Total. 

52 

37 

89 

7 

0    • 

7 

38 

18 

56 

,39 

35 

74 

13 

3 

16 

13 

6 

19 

6 

13 

19 

120 

SECTION    XVIII. 
OF      RE- ADMISSIONS  . 

1*^  Second   Admissions. 

Two  hundred  and  eighty  patients  were  each  received  a 
second  time  into  the  Asylum.  Of  these,  one  hundred  and 
sixty-eight  were  males  and  one  hundred  and  tv^elve  females. 
The  results  in  these  cases  were  as  follows : — 

Discharged  Cured, 

"  Much  improved,     . 

"  Improved, 

"  By  request  of  friends,    . 

Eloped, 

Died, 

Remaining,  Dec.  31st,  1844,  ] 

Total,  .         .         .         168         112         280 

One  of  the  females  included  among  the  cured,  eloped,  and 
one  of  the  females  among  the  improved,  is  known  to  have  re- 
covered after  leaving  the  Asylum. 

2d.  Third  Admissions. 

Forty-six  men  and  thirty-five  women,  a  total  of  eighty-one, 
were  admitted  a  third  time  each.  The  subjoined  table  ex- 
hibits the  results  in  these  cases. 


Discharged  Cured,    .... 

"  Much  improved, 

"  Improved, 

"  By  request  of  friends,     . 

Eloped, 

Died, 

Remain, 

Total,  ....     46         35         81 

One  of  the  men  included  among  the  cures  eloped. 


Males. 

Females. 

Total. 

16 

14 

30 

2 

0 

2 

8 

9 

17 

12 

8 

20 

1 

1 

2 

6 

2 

8 

1 

1 

2 

121 

3d.  Fourth  Admissions. 

Twenty-two  men  and  eleven  women,  a  total  of  thirty-three, 
were  admitted  a  fourth  time,  and  discharged  as  follows : — 

Males.         Females.  Total. 


Cured,       .... 

.     8 

7 

15 

Much  improved,    . 

1 

1 

2 

Improved, 

.     3 

1 

4 

By  reque.st  of  friends, 

8 

2 

10 

Eloped,     .... 

.     1 

0 

1 

Died, 

1 

0 

1 

Total,      ....  22  11  33 

4ith.    Fifth  Admissions. 

The  fifth  admissions  consist  of  eleven  men  and  seven 
women,  making  a  total  of  eighteen,  who  were  discharged  as 
subjoined : — 

Males. 

Cured,  ......         5 

Improved,         .         .         .         .         .4 

By  request  of  friends,      ...  0 

Died, 2 


Females. 

Total. 

5 

10 

1 

5 

1 

1 

0 

2 

Total,.         ...       11  7  18 

5fA.    Sixth  Admissions. 
Of  sixth  admissions  there  were  eight ;  two  men  and  six 
women.     They  were  discharged  as  follows  : — 

Cured, 

Improved,  .         .         .         . 

By  request  of  friends. 

Total,      ....     2  6  8 

Qth.   Seventh  Admissions. 
Two  men  and  five  women,  a  total  of  seven,  were  admitted 
a  seventh  time.  The  results  of  these  cases  were  as  follows : — 

8 


Males. 

Females. 

Total. 

1 

5 

6 

0 

1 

1 

1 

0 

1 

123 


Males. 

Females. 

Total, 

2 

3 

5 

.     0 

1 

1 

0 

1 

1 

Cured,  . 

Improved, 

Remains, 


Total,      .         .         ,         .     2  5             7 

1th.   Eighth  Admissions. 

In   the  eighth  admissions  there  are  one  man  and  three 

women  ;  whole  number  four;     Discharged  as  follows : — 

Males.         Females.  Total. 

Cured, 1  2             3 

Improved, 0  1             1 


Total 1  3 

8^^.  Ninth  Admissions. 
One  man  and  three  women ;  whole  number  four. 


Males. 

Femalei. 

Total. 

ischarged  Cured, 
"          Improved, 

1 

.     0 

2 

1 

3 
1 

Total,  ....         1 

Qth.  Tenth  Admissions. 

One  man  and  three  women ;  total  four. 


Males. 

Females. 

Total. 

Discharged  Cured, 
"           Improved, 

1 

.     0 

1 

2 

2 

2 

Total,  ...         1  3  4 

lOth.   Eleventh  Admissions. 

Of  the  men,  no  one  was  admitted  more  than  ten  times. 
Of  the  eleventh  admissions   there  were  but  three,  who 
were  all  females. 

Femalei. 

2 
.     1 


Discharged  Cured, 

"         Improved, 


Total, 


123 

llth.  Admissions  subsequent  to  the  Eleventh. 
The  cases  included   in   the  subjoined  admissions  were  all 
females. 

I2th  Adinissions,  3.  Discharged  Cured  2,  Improved  1,  Total  3. 
\^th  Admissions,  3.  Discharged  Cured  2,  Improved  1,  Total  3. 
lAth  Admissions,  3.  Discharged  Cured  2,  Improved  1,  Total  3. 
15^^  Admissions,  3.  Discharged  Cured  2,  Died  1,  Total  3. 

16th  Admissions,  2.  Discharged  Cured  1,  Request  1,  Total  2. 
llth  Admissions,  2.  Discharged  Cured  1,  Improved  1,  Total  2. 
18t?i  Adynissions,  2.  Discharged  Cured  2,  Total  2. 

IQth  Admissions,  2.  Discharged  Cured  2,  Total  2. 

20th  Admissions,  2.  Discharged  Cured  2,  Total  2. 

21st  Admissions,  2.  Discharged  Cured  2,  Total  2. 

22c?  Admission,  1.  Discharged  Cured  1,  Total  1. 

12^^.  Aggregate  Results  of  Re-admissions, 
In  the  whole  number  of  re-admissions,  from  the  second  to 
the  twenty-second,  inclusive,  there  are  four  hundred  and 
sixty-seven  cases,  of  which  two  hundred  and  fifty-four  were 
of  males,  and  two  hundred  and  thirteen  of  females.  The 
aggregate  of  their  results  is  as  follows : — 


Males. 

Females. 

Total. 

Cured,       .... 

.     87 

97 

184 

Much  improved,    . 

.    ^    10 

1 

11 

Improved, 

.     53 

40 

93 

By  request  of  friends,  *  . 

60 

47 

107 

Eloped,     .... 

.     15 

4 

19 

Died, 

22 

9 

31 

Remain,    .... 

.       7 

15 

22 

Total,         .         .         .         254       213         467 

*  In  all  cases  where  the  phrase  "  By  request  of  friends"  is  used,  the  patients 
were  probably  unimproved,  although  their  condition  is  not  mentioned  upon  the 
records. 


124 


SECTION     XIX. 

OF     RE-ADMISSIONS     IN     REFERENCE     TO     THE     CONDITION     AT     THE 
TIME    OF    DISCHARGE    ON    FIRST    ADMISSION. 

The  whole  number  of  second  admissions,  as  has  already 
been  stated,  was  two  hundred  and  eighty ;  of  which  one 
hundred  and  sixty-eight  were  men,  and  one  hundred  and 
twelve  women.  The  question  very  naturally  arises — Under 
what  circumstances  did  it  become  necessary  for  these  patients 
to  be  again  brought  to  the  Asylum  ?  Were  they  relapses, 
or  recurrences  of  the  disease,  in  the  patients  who  had  been 
discharged  cured  on  the  first  admission  ?  In  short,  what  was 
their  condition  at  the  time  of  first  discharge  ?  That  condi- 
tion is  exhibited  in  the  following  table  : — 


Cured,  .         ,         .         . 

Relieved, 

Much  improved,    . 

Improved,  .... 

By  request  of  friends, 

Eloped, 

Total,       .         .         .         168         112         280 


Of  the  two  hundred  and  eighty  who  were  admitted  a 
second  time,  one  hundred  and  five,  or  sixty-two  men  and 
forty-three  women,  were  discharged  cured,  on  their  first  ad- 
mission. These,  then,  were  cither  relapses  or  recurrences 
of  the  disease.  Several  of  them  were  cases  of  periodical 
mania. 

The  time  necessary  to  intervene  between  an  apparent  re- 
storation and  a  re-appearance  of  the  disease,  in  the  same 
patient,  in  order  to  constitute  what  may  be  called  a  recur- 


Males. 

Females. 

Total. 

62 

43 

105 

.     3 

0 

3 

7 

10 

17 

.  31 

23 

54 

54 

34 

88 

.   11 

2 

13 

125 

rence,  or  second  attack,  rather  than  a  relapse  of  the  first 
attack,  has  never  been  definitely  settled. 

In  the  table  subjoined,  we  shall  show  the  time  that  elapsed 
after  the  discharge  of  the  one  hundred  and  five  cases  that 
were  cured,  before  their  time  of  re-admission  : — 

Males.    Females.    TotaL 

Re-admitted  within  one  month  after 

first  discharge,    .         .         .         .         6         6  12 

Re-admitted  within  two  months,  ...     3         3  6 

Re- admitted  within  three  months,      ..21  3 

Re-admitted  between  three  and  six  months,  .62  8 

Re-admitted  between  six  and  twelve  months,  12         6  18 

Re-admitted  between  one  and  two  years,    .IS         8  21 

Re-admitted  between  two  and  three  years,        5         3  8 

Re-admitted  between  three  and  four  years,        4         6  10 

Re-admitted  between  four  and  five  years,          6         3  5 

Re-admitted  between  five  and  six  years,     .11  2 

Re-admitted  between  six  and  seven  years,         10  1 

Re-admitted  between  nine  and  ten  years,    .12  3 

Re-admitted  between  ten  and  eleven  years,       10  1 
Re-admitted  between  eleven  and  twelve  years,  Oil 

Re-admitted  between  thirteen  and  fourteen  y'rs,  10  1 

Re-admitted  between  seventeen  &  eighteen  y'rs,  0         1  1 


Total, 62       43       105 

In  twenty-nine  cases,  the  patient  was  absent  from  the  Asy- 
lum, after  being  discharged  cured,  less  than  six  months  ;  and 
in  eighteen,  between  six  and  twelve  months.  In  the  remain- 
ing fifty-eight,  the  period  intervening  between  the  discharge 
and  re-admission  was  more  than  one  year. 

These  one  hundred  and  five  cases  of  relapse,  or  recurrence, 
will  now  be  traced,  as  far  as  possible,  to  their  final  results. 
Those  results  are  embodied  in  the  foregoing  table  of  re- 
admissions  ;  but  they  will  be  here  separately  enumerated, 
for  the  purpose  of  giving  a  more  complete  history  of  the 
cases  discharged  cured,  in  the  first  admissions.  The  results 
of  their  second  admissions  were  as  follows  : — 


126 

Males.         Females.  Total. 


Discharged  Cured, 

"           Much  improved,     . 

"           Improved,  . 

"           By  request  of  friends, 

Eloped,       . 

Died,     . 

31 

.       2 

12 

6 

4 

.       6 

23 
0 
6 
6 
1 
2 

54 

2 

18 

12 

5 

8 

Remaining,          .... 

1 

5 

G 

.      Total,    ....     62  43         105 

Twelve  men  and  five  M^omen  were  admitted  a  third  time 
each  ;  and  all  were  discharged  cured. 

Eight  men  and  three  women  were  admitted  a  fourth  time  ; 
and  discharged,  one  man  by  request,  one  man  improved,  and 
all  the  rest,  of  both  sexes,  cured. 

Two  men  and  two  women  were  admitted  a  fifth  time,  and 
all  discharged  cured. 

Two  women  were  admitted  a  sixth  time,  and  discharged 
cured. 

One  woman  was  admitted  sixteen  times  more,  (twenty- 
two  admissions  in  all,)  and  discharged  cured,  each  time. 
This  was  a  case  of  mania ;  not  precisely  periodical,  but  re- 
current at  short  intervals. 


127 


SECTION    XX. 
TIME  OF  RESIDENCE   IN    THE  ASYLUM  OF  THE  PATIENTS  RE-ADMITTED. 

Table  L— Showing  the  time  of  residence  on  Second  Admission. 


Time. 

M. 

F. 

T. 

Time. 

M 

F. 

T. 

Time. 

M. 

F. 

3 
3 

T. 

9 

7 

4days 
5days 
6  days 
Tdays 
8days 

1 
0 

0 

1 

1 

1 

1  month 
IJmonths 

5 
5 

1 

4      91  year 
7    121    "  2mos 

6 
4 

0 

1 

1 

2  months 

7 

12 

191    "  3mos 

6 

3 

9 

1 

2 

2^months 

7 

4 

111    "  6mos 

3 

1 

4 

0 

1 

3  months 

14 

8 

221    "9mos 

2 

1 

3 

J      1 

9days 

1 

2 

3^months 

8 

4 

12 

2   years 

2 

1 
0 

t 

3 

10 days 
11  days 
14 days 
15  days 
16 days 
17days 
ISdays 

0 

1 

4  months 

12 

1 

13 

2|  years 

3 

3 

0 

1 

4^months 

5 

2 

7; 

3    years 

1 

5 

6 

1 

3 

5  months 

5 

4 

9 

3 1  years 

1 

3 

4 

0 

1 

S^months 

4 

3 

7 

4   years 

0 

2 

2 

0 

2'  6  months 

5 

2 

7' 

6    years 

4 

0 

4 

1 

2 

6^  months 

0 

4 

4' 

6    years 

2 

0 

2 

1 

1 

7  months 

7 

3 

10 

7   years 

1 

0 

19days 
20days 
21  days 
22days 
23days 

0 

1 

7^  months 

1 

2 

8    years 

0 

0 

1 

8  months 

4 

5 

9    years 

1 

0 

.' 

0 

1 

S^months 

3 

4 

11    years 

1 

0 

J  1 

1 

2 

9  months 

2 

3 

13   years 

1 

0 

0 

1 

10  months 

2 

3 

14   years 

2 

0 

2 

24 days 

0 

1 

10 1  months 

4 

0 

4 

More  than  1  yr 

40 

23 

63 

25days 
26days 
28days 

1 

2 

11 'months 

1 

2 

3 

1  month  to  1  yr 

102 

66 

168 

c 

0 

1 

1 
1 

11^  months 

1 

1 

2 

Less  than  1  mc 

20 

10 

30 

Total. 

2C 

IC 

30 

l02 

66168 

16-2 

9E 

261 

Nineteen  cases  of  Second  Admission    had  not  been  dis- 
charged. 


128 


Table  ii. — Time  of  residence  in  the  Asylum  of  all  cases  of  Re- 
admission,  from  the  third  to  the  twenty-second,  inclusive. 


Time. 

M. 

F. 

T. 

Time. 

M. 

F. 

T. 

Time, 

M. 

F. 

T. 

5days 

] 

0 

I 

1  month 

5 

5 

10 

1  year 

3 

0 

3 

6days 

2 

0 

2 

l^months 

6 

6 

12 

1  yr  2  mo 

4 

1 

5 

7davs 

1 

J 

2 

2  months 

3 

4 

7 

1   yr  6  mo 

0 

4 

4 

8days 

0 

1 

1 

2^months 

2 

4 

6 

1  yr  9  mo 

2 

0 

2 

9days 

0 

1 

1 

3  months 

6 

4 

10 

2    years 

4 

0 

4 

lOdays 

0 

1 

1 

S^months 

4 

4 

8 

2J  years 

1 

1 

2 

lldays 

0 

1 

1 

4  months 

1 

6 

7 

3    years 

2 

1 

3 

12days 

1 

1 

2 

4^months 

3 

2 

5 

4    years 

3 

1 

4 

ISdays 

1 

2 

3 

5  months 

1 

3 

4 

5    years 

1 

2 

14days 

1 

2 

3 

5jmonths 

1 

4 

5 

6    years 

2 

3 

ISdays 

0 

1 

1 

6  months 

5 

1 

6 

8    years 

0 

1 

16days 

0 

1 

1 

G^months 

1 

2 

3 

9    years 

1 

2 

ITdays 

0 

2 

2 

7  months 

4 

3 

7 

14    years 

0 

1 

ISdays 

0 

2 

2 

7^months 

2 

1 

3 

19days 

1 

2 

3 

8  months 

0 

3 

3 

More  than 

20days 

0 

2 

2 

Simonths 

1 

0 

1 

1  year 

24 

12 

36 

21 days 

1 

2 

9  months 

1 

1 

2 

From  Imo 

23days 

0 

1 

9jmonths 

1 

1 

2 

tol  yr 

49 

56 

105 

24days 

0 

1 

10  months 

0 

1 

1 

Under 

25days 

1 

2 

lO^months 

2 

1 

3 

1  month 

12 

29 

41 

26days 

0 

1 

27days 

0 

3 

3 

28days 

2 

1 

3 

Total, 

1229 

41 

Total, 

49 

56 

105 

Total, 

85 

97 

182 

Three  patients  had  not  been  discharged. 


139 


SECTION  XXI. 
MORTALITY. 

There  are  two  causes,  the  effect  of  which  is  to  make  the 
comparative  number  of  deaths  in  this  Asylum,  greater  than 
that  of  some  other  institutions  of  a  similar  description. 

The  first  is  found  in  the  fact  that,  in  receiving  patients,  no 
discrimination  is  made  in  regard  to  the  form  of  disease,  its 
duration  or  supposed  curability.  Idiots,  the  imbecile,  demen- 
ted epileptics  and  disabled  paralytics  have,  alike  w  ith  more 
favorable  cases,  been  considered  as  proper  objects  for  such 
assistance  as  the  institution  was  able  to  render.  This  unre- 
stricted admission  of  applicants,  unfavorable  in  regard  to 
mortality  in  any  institution,  is  particularly  so  for  one  situ- 
ated in  the  vicinity  of  a  large  city.  For,  in  the  latter  case, 
some  patients  too  feeble  to  endure  a  long  journey  are  re- 
moved to  it ;  and  the  same  may  be  said  of  cases  of  acute  in- 
flammation of  the  brain,  a  disease  severe  in  its  symptoms,  of 
short  duration  and  almost  invariably  fatal,  especially  if  the 
patient  be  subjected  to  the  agitation  and  exercise  of  travel- 
ing even  a  few  miles. 

The  second  cause  alluded  to  is  the  comparative  antiquity 
of  the  institution.  Rarely,  if  ever,  in  the  early  years  of  an 
Asylum,  does  the  mortality  rise  to  a  large  per  centage. 
The  tendency,  at  all  institutions,  is  towards  the  accumulation 
of  incurable  patients,  destined  to  remain  throughout  their 
lives.  Such  is  the  state  of  things  here ;  so  that,  frequently, 
if  not  generally,  the  majority  of  the  annual  number  of  deaths 
is  among  patients  who  have  been  in  the  Asylum  from  one  to 
twenty  years.  As  an  illustration  of  this  fact,  it  may  be  men- 
tioned that,  of  thirteen  patients  who  died  in  184G,  only  four 
were  among  the  patients  admitted  in  that  year.  The  follow- 
ing table  includes  the  whole  number  of  deaths  of  insane  pa- 


Total, 

227 

Of  254  males, 
Of  213  females. 

22  died. 
9  died. 

130 

tients,  from  the  opening  of  the  institution  to  December  31st 
1844. 

First  admissions  j  ^f  1090  males,         -       148  died. 
(Oi    751  females,     -         79  died. 


Re-admissions 


Total,         31 

Hence  is  derived  the  following  aggregate  of  cases,  distin- 
guished according  to  sex. 

Males,  of  1344  cases  admitted,  170  died. 
Females,  of  964  cases  admitted,  88  died. 
Both  sexes,  of  2308     cases  admitted,     258     died. 

The  proportion  of  the  whole  number  of  deaths,  calculated 
upon  the  whole  number  of  admissions,  is,  for  men,  12.64  per 
cent,  for  women,  9.12  per  cent,  and  for  both  sexes,  11.18  per 
cent. 

This  estimate  is  made  upon  the  whole  number  of  cases  ad- 
mitted. But,  as  has  already  been  stated,  the  whole  number 
o£  persons  was  but  1841,  of  whom  1090  were  males  and  751 
females.  Of  these,  one  hundred  and  seventy  males  and 
eighty-eight  females,  a  total  of  two  hundred  and  fifty-eight* 
died.  Therefore,  the  proportion  of  deaths  of  all  the  persons 
admitted,  was,  for  men,  15.60  per  cent,  for  women,  11.71,  and 
for  both  sexes.  14.01. 

It  has  been  very  clearly  demonstrated  by  Samuel  Tuke, 
whose  authority  is  second  to  none,  in  all  matters  upon  which 
he  has  written  in  reference  to  insanity  and  the  insane,  that 
the  true  and  only  accurate  method  of  estimating  the  mortali- 
ty in  an  institution,  is,  not  to  calculate  the  proportion  of 
deaths  upon  the  number  admitted,  nor,  as  is  sometimes  done, 
upon  the  number  discharged,  but  upon  the  mean  or  average 
number  of  patients,  annually  resident  in  the  institution. 


131 

It  is  manifest  that,  for  the  purpose  of  ascertaining  the  per 
centage  of  mortality  in  the  city  of  New- York,  during  any 
given  year,  it  would  be  necessary  to  divide  the  number  of 
deaths  by  the  average  number  of  the  whole  population,  and 
not  by  that  population  increased  by  the  tens  of  thousands  of 
persons  who  may  have  come  into  the  city,  during  the  year» 
and  remained  but  a  few  days,  or,  at  most,  but  a  few  weeks. 
This  rule,  evidently  applicable  for  a  city,  must  be  equally  so 
for  a  public  institution  of  this  description,  in  which  a  large 
proportion  of  patients  remain  more  than  one  year. 

In  Part  First,  it  has  been  shown  that  the  daily  average 
number  of  patients,  for  the  whole  period  of  twenty-three  and 
a  half  years  over  which  these  statistics  extend,  was  110.44. 
That  number,  however,  includes  the  cases  of  delirium  tre- 
mens. The  average  number  of  insane  patients  was  105. 
The  average  annual  number  of  deaths  has  been  shown  to 
have  been  11.18;  hence  the  mean  annual  per  centage  of 
deaths,  of  both  sexes,  was  10.65. 

The  following  table  exhibits  the  per  centage  for  each  year. 


Year. 

Per  cent. 

Year. 

Per  cent. 

Year. 

Per  cent. 

1821 

3.29 

1829 

11,43 

1837 

9.61 

1822 

3.65 

1830 

7.23 

1838 

12.57 

1823 

5.18 

1831 

19.55 

1839 

8.94 

1824 

8.06 

1832 

17.92 

1840 

9.58 

1825 

1.73 

1833 

11.12 

1841 

14.28 

1826 

13.41 

1834 

14.54 

1842 

5.21 

1827 

8.20 

1835 

10.38 

1843 

13.84 

1828 

16.87 

1836 

9.90 

1844 

11.53 

132 


SECTION   XXII. 
MORTALITY     IN     ITS    RELATION    TO    MONTHS    AND    SEASONS. 

The  two  hundred  and  fifty-eight  deaths  are  arranged  be- 
low, according  to  the  months  and  seasons  in  which  they  oc- 
curred. 


Sprint 


Total,    .25       13 


38 


Summer. 


Males.  Females  Total 

Males.  Females.  Total 

March,    . 

.       4         4         8 

June, 

.     12        14       26 

April, 

.10         6       16 

July,    .     . 

.       9         7        16 

May, 

.11          3       14 

August,   . 

,22         6       28 

Total, 


43       27 


70 


Autumn. 


Total, 


54       33       87 


Winter. 


Males 

Females. 

Total. 

Males. 

Females,  Total 

September, 

22 

8 

30 

December, 

12 

4       16 

October, 

13 

13 

26 

January, 

21 

8       29 

November,  . 

19 

12 

31 

February,    . 

15 

3        18 

Total,    .48       15       63 


Of  monthly  deaths,  the  greatest  number,  for  men,  was 
twenty-two,  the  number  being  equal  in  both  August  and  Sep- 
tember ;  for  women  it  was  fourteen,  in  June  ;  and  for  both 
sexes,  thirty-one,  in  November. 

Of  the  seasons,  in  reference  to  men.  Autumn  holds  the  first 
rank,  Winter  the  second.  Summer  the  third  and  Spring  the 
fourth.  For  the  women.  Autumn  is  first,  Summer  next,  Win- 
ter the  third  and  Spring  the  last. 

For  both  sexes,  the  maximum  number  of  deaths  was  in 
Autumn,  the  next  in  Summer,  the  third  in  Winter  and  the 
minimum  in  Spring. 


133 


SECTION    XXIII. 
TIME    OF    RESIDENCE    IN    THE    ASYLUM,     OF    PATIENTS    WHO    DIED. 

The  subjoined   table  shows  the  time  of  residence   in  the 
Asylum,  of  all  patients  who  died  on  their  first  admission. 


Time. 

M. 

F.  T. 

Time. 

M. 

F. 

T. 

Time. 

M. 

F 

T. 

2  days 

2 

2    4 

1    month 

8 

3 

11 

1  year 

2 

4 

6 

3  days 

1 

0 

1 

H  months 

16 

7 

23 

1  yr  3  mo 

3 

1 

4 

4  days 

0 

1 

1 

2    months 

8 

3 

11 

1  yr  6  mo 

2 

0 

2 

6  days 

4 

1 

5 

21  months 

4 

2 

6 

1  yr  9  mo 

2 

1 

3 

7  days 

2 

1 

3 

3    months 

3 

3 

6 

2    years 

7 

4 

11 

8  days 

2 

0 

2 

3|  months 

4 

1 

5 

2L  years 

3 

2 

5 

9  days 

2 

1 

3 

4    months 

1 

3 

4 

3    years 

2 

0 

2 

10  days 

6 

2 

8 

4:h  months 

3 

1 

4 

3i  years 

0 

1 

1 

11  days 

2 

1 

3 

5    months 

4 

6 

10 

4    years 

2 

0 

2 

12  days 

0 

1 

1 

5\  months 

1 

1 

2    4j  years 

1 

0 

1 

13  days 

1 

1 

2 

6    months 

5 

0 

5    5    years 

1 

1 

2 

14  days 

1 

0 

1 

6i  months 

2 

2 

4 

6    years 

3 

0 

3 

15  days 

2 

1 

3 

7    months 

5 

2 

7 

7    years 

0 

2 

2 

16  days 

2 

1 

3 

7^  months 

2 

0 

2 

8    years 

2 

0 

2 

17  days 

0 

1 

1 

8    months 

1 

0 

1 

9    years 

0 

1 

1 

18  days 

2 

2 

4 

SI  months 

3 

0 

3 

10    years 

1 

0 

1 

21  days 

2 

0 

2 

9    months 

I'l^ 

3,11    years 

2 

0 

2 

22  days 

1 

2 

3 

9i  months 

3,'   1 

4,12    years 

0 

1 

1 

23  days 

1 

0 

1 

10    months 

1 

0 

L 

13    years 

0 

1 

1 

24  days 

2 

1 

3 

11    months 

1 

0 

1 

16    years 

1 

0 

1 

25  days 

28  days 

29  days 

0 
1 
1 

2 
1 
0 

2 

2 

1 

111  months 

1 

1 

2 

1 

r^xro-f    1    tTfiQ-r 

34 

19 

53 

Total 

77 

3S 

115  1  mo  to  1  yr 

77 

38 

115 

less  than  Imo 

37 

22 
79 

59 

Total 

37 

22 

59 

A| 

?gi 

•eg 

ate  of  deaths 

01 

afi 

rst  a 

dmission 

148 

227 

Fourteen  patients  died  within  the  first  week  after  their 
admission,  twenty  during  the  second  week,  thirteen  during 
the  third  and  eleven  during  the  fourth.  Fifty-nine,  or 
twenty-six  per  cent  of  the  whole  number  of  deaths,  occurred 
within  the  first  month  after  admission. 


134 

In  subsequent  admissions,  it  is  not  to  be  supposed  that  so 
large  a  proportion  of  the  cases  would  prove  fatal  in  the  early 
period  of  residence  in  the  Asylum,  because  the  disease,  in 
most  cases,  is  less  acute. 

Of  the  patients  who  died,  upon  re-admission,  the  term  of 
residence,  from  the  time  of  their  last  admission,  is  indicated 
in  the  subjoined  table. 


Time. 

Males.Femal 

Total .' 

Time, 

Males. 'Femal. 

Total, 

7     days 

1 

0 

1 

1  year 

0 

2 

2 

1     month 

1 

1 

2 

1  year  &  6  mos 

0 

1 

1 

3     months 

2 

0 

2 

1  year  &  9  mos 

2 

0 

2 

4     months 

0 

1 

1 

2  years 

2 

0 

2 

4^^   months 

0 

1 

1 

6  years 

1 

0 

1 

6^  months 

1 

1 

2 

7  years 

1 

X 

0 

1 

7     months 

1 

0 

1 

9  years 

2 

0 

2 

8     months 

2 

1 

3 

10  years 

1 

0 

1 

9     months 

1 

1 

2 

13  years 

1 

0 

1 

91   months 
1 1^  months 

1 
1 

0 
0 

1 
1 

14  years 

1 

0 

1 

1  year  and  over. 
less  than  1  year 

11 
11 

3 
6 

14 
17 

Total 

11 

6 

17 

Total 

22 

9 

31 

Of  these  thirty-one  cases,  death  occurred  in  only  three 
during  the  first  month,  and  in  but  seventeen  during  the  first 
year. 


135 

SECTION     XXIV. 
MORTALITY     IN     RELATION     TO     AGE. 

In  the  following  table,  the  whole  number  of  patients  who 
died  on  first  admission,  as  well  as  those  on  re-admission, 
are  arranged  according  to  their  ages  at  time  of  death. 


TIME. 

FIRST 
ADMISSION. 

SUBSEQUENT 
ADMISSIONS. 

AGGREGATE. 

Males. 

Femal 

Total. 

Males. 

Fema 

0 

1 

0 

1 

0 

1 
1 
1 
1 

2 
0 
1 
0 
0 

Total. 

Males. 

Fema. 

Total. 

Under  20  yrs. 
From  20  to  25  yrs. 
From  25  to  30  yrs. 
From  30  to  35  yrs. 
From  35  to  40  yrs. 
From  40  to  45  yrs. 
From  45  to  50  yrs. 
From  50  to  55  yrs. 
From  55  to  60  yrs. 
From  60  to  65  yrs. 
From  65  to  70  yrs. 
From  70  to  75  yrs. 
From  75  to  80  yrs. 
From  80  to  85  yrs. 

5 

10 

12 

16 

25 

16 

7 

23 

4 

5 

4 

2 

3 

2 

2 
9 

10 
9 

10 
4 
4 
9 
1 
8 
0 
4 
1 
1 

7 

19 

22 

25 

35 

20 

11 

32 

5 

13 

4 

6 

4 

3 

0 
0 

1 

3 
1 
1 
3 
4 
3 
3 
0 
0 
0 
2 

0 

1 
1 

4 
1 
2 
4 
5 
4 
5 
0 
1 
0 
2 

5 

10 

13 

19 

26 

17 

10 

27 

7 

8 

4 

2 

3 

4 

2 

10 

10 

10 

10 

5 

5 

10 

2 

10 

0 

5 

1 

1 

81 

7 

20 

23 

29 

36 

22 

15 

37 

9 

18 

4 

7 

4 

5 

Total 

134 

72 

206 

21 

9 

30 

155 

236 

Of  the  patients  who  died  on  first  admission,  the  maximum 
number  was  of  persons  between  thirty-five  and  forty  years 
of  age. 

Among  the  re-admissions,  it  will  be  perceived,  as  might 
be  expected,  that  the  greatest  number  of  deaths  occurred  in 
the  more  ad,vanced  stages  of  life.  Hence,  in  the  aggregate, 
the  greatest  mortality  was  in  the  period  of  from  fifty  to  fifty- 
five  years. 


136 


SECTION    XXV. 
DISEASES     RESULTING     IN     DEATH. 

The  causes  of  death,  or  the  diseases  which  terminated  fa- 
tally, SO  far  as  they  are  recorded,  are  included  in  the  follow- 
ing table. 

1st.  Deaths  on  first  Admission. 


Apoplexy,Congest'n  of  brain,  1 5 
Asthenia,  Atrophy,  •  .  16 
Abcess,  Lumbar,      ...       1 

Abcess  of  liver 1 

Concussion  of  brain,  .  .  2 
Convulsions,  Epilepti-form,  4 
Cholera-morbus,  ...  2 
Cholera,  Asiatic,      ...       2 

Cancer, 1 

Consumption,       .     .     .     -21 

Dropsy, 2 

Diarrhoea, 5 

Dysentery, 7 

Disease  of  heart,      ...       1 


Epilepsy,        ......  9 

Erysipelas, 1 

Fever  Typhoid,       ...  6 

"      Bilious  remittent,  1 

"       Intermittent,     .     .  1 

"       Scarlet,    ....  1 

Inflammation  of  bowels,  3 

Inflammation  of  brain,     .  10 

Inanition,       .....  3 

Paralysis, 19 

Suicide, 8 

Strangulation  while  eat- 
ing, (paralytic)    ...  2 


2d.  Deaths  on  Re-admission. 


Apoplexy,       4 

Asthenia,  Marasmus,   .     .  3 

Consumption,       ....  1 

Dropsy, 1 

Diarrhoea, 2 


Dysentery, 1 

Disease  of  heart,    ...  1 

Epilepsy,       2 

Paralysis, 4 


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